NHS England makes selective internal radiation therapy (SIRT) available via new commissioning procedure

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NHS England is inviting specialist hospitals to take part in a new, innovative commissioning approach called ‘commissioning through evaluation’, which is aimed at increasing access to services or treatments which are not currently routinely funded by the NHS. The NHS revision of Clinical Policy Commissioning Statement on SIRT will allow patients in England with metastatic colorectal cancer and intrahepatic cholangiocarcinoma who may benefit from SIR-Spheres microspheres to get treatment in specialist NHS centres, a press release from Sirtex states.

The NHS does not routinely fund SIRT as the current evidence base does not yet demonstrate sufficient clinical and cost effectiveness for its routine use. However, a news article, posted on the NHS England site states that a number of patients in England are participating in an international research trial, which is looking at the use of SIRT as a ‘first line’ cancer treatment. The article also states that NHS England’s ‘commissioning through evaluation’ programme, however, is focusing on SIRT as a treatment in those situations where other more routine approaches, such as surgery and chemotherapy, have been tried first but have not been successful.

A company press release from Sirtex states that NHS England has issued an interim Clinical Commissioning Policy Statement that updates its policy on Selective Internal Radiation Therapy (SIRT) for use in treating eligible patients with metastatic colorectal cancer and intrahepatic cholangiocarcinoma. As a result of the NHS announcement, which can be found at http://www.england.nhs.uk/2013/09/26/com-through-eval, SIR-Spheres microspheres are now one of the first medical technologies that will be made available in specialist NHS centres. The initiative allows specialist NHS centres to use services like SIRT, whose initial safety and efficacy has been shown and supported by guidance from the National Institute for Clinical Excellence (NICE), but still require further evidence of relative clinical and cost effectiveness to support routine commissioning.

The ‘commissioning through evaluation’ statement on SIRT was developed by NHS England in collaboration with the Clinical Reference Groups for radiotherapy, hepatobiliary and pancreas, and interventional radiology. The outcomes of the use of SIRT under ‘commissioning through evaluation’ will be evaluated in 2014.

“This announcement brings a moment of very good news to the large number of patients with liver metastases from colorectal cancer who have previously received chemotherapy and biological treatments, many of whom have been waiting for several difficult months in anticipation of this announcement,” said Ricky Sharma, consultant oncologist at the Oxford University Hospitals NHS Trust. “It is also excellent news for patients with cholangiocarcinoma, a rare and aggressive form of liver cancer for which there are very few treatments available. Enabling suitable patients across the whole of England to have access to SIRT in this important evaluation process represents a significant advance for the NHS.”

The NHS commissioning statement recognises that SIRT should not routinely be used in the initial treatment of metastatic colorectal cancer, for which chemotherapy and biological therapy are the current standards of care. The new NHS statement language notes that metastatic colorectal cancer patients who are chemorefractory may be offered SIRT at NHS specialist centres under the new process, or encouraged to enrol in other SIRT clinical trials if applicable.

NHS policy for SIRT in intrahepatic cholangiocarcinoma

The NHS recognises that few proven treatments exist for intrahepatic cholangiocarcinoma and recommends that SIRT may now be offered to chemorefractory patients at NHS specialist centres under the new commissioning process.

NHS policy on patient selection criteria

In addition to the use of SIRT in treating patients with liver tumours due to metastatic colorectal cancer and intrahepatic cholangiocarcinoma, NHS England is looking into whether they should employ a similar scheme of commissioning through evaluation for patients with hepatocellular carcinoma following recent NICE guidance supporting SIRT in hepatocellular carcinoma. To be eligible for SIRT for treating any of these forms of liver tumours, NHS states that patients must have or be:

 

  • Not amenable to surgical resection of the liver
  • Not suitable for treatment with radiofrequency ablation
  • WHO performance status 0-1
  • Disease that is predominantly located in the liver, with no life-threatening disease outside of the liver
  • Adequate liver function
  • Less than 60% of the liver involved by tumour
  • No ascites or other signs of liver failure
  • A life expectancy of greater than three months
  • Not pregnant.
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