A little bit of hope

Symptoms of incurable lung disease mesothelioma include chest pain, persistent cough and breathlessness. Photograph: Frank Baron

The last three months were the happiest of Arthur's life, because he put his whole life into them. You can't put a price on that."

Cora Tiffin lost her husband, Arthur, to lung disease mesothelioma. She attributes his final three months to taking the drug Alimta.

"The treatment keeps people going longer," says Tiffin. "It doesn't work for everyone but everyone should have the opportunity to try it. What other treatments have we got?

"When Arthur was diagnosed with mesothelioma, it was heartbreaking. But all of a sudden, with Alimta, there was a little bit of hope."

Mesothelioma, a form of cancer affecting the lung lining, is most commonly caused by asbestos and is most prevalent among construction workers who handled asbestos in the 1950s and 1960s before the dangers of the fibrous material were widely known. Set to peak by 2015 with UK cases reaching 2,000 a year, 60,000 cases are expected between now and 2050.

Alimta is one of the most commonly prescribed drugs to tackle the incurable disease. It is reported to significantly extend life expectancy and helps to relieve symptoms including breathlessness, chest pain, persistent cough and loss of appetite. It is available in some areas of the UK, but it is not widely prescribed on the NHS.

Last month, an appeal was held into the decision by the medicines watchdog, the National Institute for Health and Clinical Excellence (Nice), to license Alimta. The hearing is the latest hurdle in a long battle to help mesothelioma patients access the drug on the NHS.

Nice decided against licensing Alimta on the NHS in June 2006 but then reversed its decision following an appeal in October 2006, recommending the drug for treatment of patients in the most advanced stages of the disease.

The Alimta lobby - including manufacturers Eli Lilly and 14 patient and support groups - was delighted with the victory, having lobbied hard for almost two years.

But the appeal – brought by Birmingham north and east primary care trust, the Royal College of Physicians and the Association for Cancer Physicians - could result in a new decision to restrict Alimta prescriptions.
Nice, which holds its annual conference this week, must decide whether expensive but effective drugs such as Alimta should be funded out of the NHS budget. In some cases, it has taken the controversial decision that a drug is not financially viable, or even possible, to be licensed.
Alimta is available in most other European countries and was approved in the US by the Food and Drink Authority in February 2004.

But in the UK, even if Nice upholds its decision at the appeal, the process will delay final guidance further and causes disappointment for patients and support groups whose access to the drug is now further postponed or potentially restricted.

Nice's appraisal of Alimta has involved 46 stakeholders, including the Department of Health, two primary care trusts, Eli Lilly, charities and patient support groups. But it will not be known until the day of the hearing which of them has brought the appeal against Nice's decision.

Jeremy Steele, a consultant oncologist who has supported the campaign for Alimta to become available on the NHS, said: "It's a great shame that a small issue around cost will now delay patients' access to the drug further. This has been such a slow and frustrating process.

"The appeal panel was very fair and pointed out that the grounds of the appeals were not based on anything fundamental.

"I'm confident that the drug will still be recommended by Nice, but access for patients will now be at least several months away.

source:http://www.guardian.co.uk/society/2007/dec/03/cancer.drug