Everolimus: from April, it will no longer be available in England to treat breast cancer (Image: P. Marazzi/SPL)

Changes to England’s Cancer Drugs Fund mean that from April, new cancer patients will no longer be able to receive a number of expensive treatments – including three breast cancer medicines – that have hitherto been available on the National Health Service.

Established in 2011, the CDF currently spends £280 million annually on cancer treatments that are too expensive to be otherwise approved for use by NHS England. The decision has now been taken to remove nine drugs from the CDF’s approved shopping list because they are deemed to offer too little value for money, even for this special fund. For several other drugs, the number of indications – the conditions under which they can be used – has been reduced. In total, this means that 25 treatment options for specific cancers will no longer be available. .

The move comes as part of an NHS England review of the CDF, which has been much criticised as a temporary fix for the problem of expensive medicines, and for being unfair to those who suffer from any other type of disease – for which only standard NHS-approved medicines can be used.


A few new drugs have been added to the list, including panitumumab, a treatment for bowel cancer, and the annual budget for the CDF will rise to around £340 million, according to the review, which was published yesterday.

Budget bust

In its announcement, NHS England said it has also negotiated price reductions on a number of drugs which, among other measures, will make savings of about £80 million. Without these changes, NHS England says the fund’s spending would have risen to around £420 million.

The changes offer mixed news for people with cancer. The fund normally supports palliative treatment, enabling people with metastatic cancers – those that have spread from their original site – to access drugs that can add several months to their lives. From this April, only people who are already started on the treatments in question will receive them. Patients who had been hoping to begin treatment will no longer be able to do so.

Drug companies meanwhile have been calling for a total overhaul of how the NHS decides which cancer drugs are worth splashing out on. New cancer drugs are typically more expensive than other drugs, and the pharmaceutical industry often claims that this is because they cost billions to develop. But Richard Sullivan of Kings College London says that many have criticised these estimates as grossly overinflated.

Unfair fund

“[For] a new cancer drug, the prices are set as high as the market will bear,” says Sullivan. For this reason, he argues that the CDF should be abolished. He says the fund is unfair, as it makes a special exception for cancer medicines, excluding other diseases or non-drug treatments. Health economist Karl Claxton of the University of York, UK, agrees, saying that health and life expectancy would be better if the money were spent on the NHS as a whole.

“The CDF was introduced for the wrong reasons, but has changed the whole treatment landscape as well as patient expectations. Removing it now would only make the situation worse,” says Leslie Galloway, chairwoman of the Ethical Medicines Industry Group, which represents smaller drug and biotech firms. She criticises the CDF for allowing big companies to sidestep the standard NHS drug-approval system, but adds that it is not the pharmaceutical industry’s fault for taking the money if the government is foolish enough to pay full price for these medicines. “Just stop paying the full price!”

But for some firms, adding a high price tag to innovative medicines can spell their doom. In 2010, Provenge was the first cancer treatment to be approved that fights tumours using a patient’s own immune system. The landmark immunotherapy treatment was predicted to bring in $4 billion a year for Dendreon, the company that developed it. But uptake of the therapy has been low, because one course of treatment costs $93,000. Four years on, Dendreon has filed for bankruptcy protection.