National Health Service (NHS) England have announced that selective internal radiation therapy (SIRT) using yttrium-90 (Y-90) microspheres will now be routinely commissioned for NHS patients with advanced colorectal cancer that has spread to the liver and is not responding to standard chemotherapies.
The use of SIRT in the NHS was assessed by NHS England from January 2014 to March 2017, as part of their Commissioning through Evaluation (CtE) scheme and the results of the assessment were published by the National Institute of Care Excellence (NICE) and NHS England in October 2017.
The findings were also published online as a scientific paper in the Journal Clinical Oncology by consultant radiation oncologist Ricky Sharma (chair of radiation oncology, University College London, London, UK) and his colleagues in September 2018, which confirmed that the real-world experience of SIRT in the NHS is consistent with the published literature.
Since 2017, NHS England has been considering the case for routine commissioning of SIRT, and they have reached the conclusion that the evidence base on SIR-Spheres resin microspheres (Sirtex) is sufficient to offer SIRT as a routine treatment for patients with colorectal cancer that has spread to the liver who meet certain criteria.
In the Clinical Commissioning Policy paper: Selective Internal Radiation Therapy (SIRT) for chemotherapy refractory/intolerant metastatic colorectal cancer (adults), NHS England recommends that adults with chemotherapy refractory or chemotherapy intolerant unresectable, liver-only metastatic colorectal cancer that meet all of the eligibility criteria will be able to be treated with SIRT using Y-90 microspheres.
Patients with advanced bowel cancer will have to meet certain criteria to be eligible for the treatment on the NHS. Specialist liver centres in England which satisfy the criteria specified by NHS England will be able to routinely offer this procedure.
“The decision by NHS England to locally commission SIRT from April  is an enormous relief for patients with bowel cancer that has spread to the liver. These patients often need disease control within the liver and have limited treatment options. As long as patients meet NHS England’s clinical criteria for SIRT, treated in expert liver centres—there is likely to be benefit in controlling the liver spread,” comments Harpreet Wasan, consultant in medical oncology (London, UK). Wasan was co-chief investigator for the FOXFIRE trial of SIRT in liver metastases.
The liver metastases should be inoperable, and the disease should not be responding to standard chemotherapies. For patients with other cancers that may benefit from SIRT, such as primary cancers of the liver, the policy proposals are still being reviewed.
Patients who do not qualify for this treatment by the NHS criteria may be able to receive SIRT by participating in a clinical trial, by submitting Individual funding requests via their oncologist, or pay for it privately.
“In specialist centres we have the possibility to treat patients with innovative treatments such as SIR-Spheres Y-90 resin microspheres, which is a unique way to treat liver tumours with internal radiation therapy without damaging the healthy liver. It is great news that we now have the possibility to discuss this treatment option during the multidisciplinary team meetings for all patients who could benefit from it (meeting eligibility criteria)” states Jon Bell, consultant interventional radiologist at the Christie NHS Foundation Trust, Manchester, UK.
Sharma says: “We are delighted by this announcement. Our study has confirmed that the real-world experience of SIRT as a cancer treatment in the NHS is consistent with the published data from other countries. There is still scope for improving access to this specialist treatment for patients with a variety of cancers, not just bowel cancer, and across all the nations of the UK, not just England.”
“The NHS England decision to fund internal radiation therapy to treat liver tumours is a significant development that offers new hope for patients with aggressive bowel cancer. We were very concerned for those patients who needed the treatment but who were unable to fund it privately or raise funds to receive it. Patients in England with liver cancer that has spread from their bowel and who have exhausted other treatments, now have access to a therapy which can extend their survival so that they can spend extra time with their loved ones and enjoy more life. These patients have very few treatment options, so this is a really important step,” says Vanessa Hebditch, director of policy at the British Liver Trust.
SIR-Spheres Y-90 resin microspheres are approved for use in Argentina, Australia, Brazil, the European Union (CE Mark), Switzerland, Turkey, and several countries in Asia for the treatment of unresectable liver tumours. In the USA, SIR-Spheres Y-90 resin microspheres have a Pre-Market Approval (PMA) from the US Food and Drug Administration (FDA) and are indicated for the treatment of unresectable metastatic liver tumours from primary colorectal cancer with adjuvant intra-hepatic artery chemotherapy (IHAC) of FUDR (floxuridine).