Beating bowel cancer together

NHS England has updated interim treatment options during the COVID-19 pandemic

Thursday 25 March 2021

Interim treatment options which have allowed for greater flexibility in the management of bowel cancer during the COVID-19 pandemic will remain in place for some months, NHS England has said today. The drug pembrolizumab has also been added as a treatment option for some people with bowel cancer that has spread to other parts of the body (also known as advanced bowel cancer).

These interim arrangements have helped to ensure treatment options are available for bowel cancer patients, and those with other types of cancer, throughout the crisis. They include changes to the way drugs are normally given for bowel cancer, or new drugs that are not yet approved by the National Institute for Health and Care Excellence (NICE) that have been granted temporary permission to be used during the pandemic.

People who began an interim treatment during the pandemic will be allowed to continue taking the treatment until they and their clinician decide together that it's time to stop, or to switch to a different treatment. This guidance will remain until at least 1 July 2021, when another review will take place to see if these interim treatments need to continue for longer.

NHS England recommends that for some bowel cancer patients the following options may be available, though patients could speak to their clinical team to find out more.

  • You may be able to have intermittent treatment with chemotherapy that contain the drugs cetuximab or panitumumab. This is to help reduce the need for treatments that reduce the body's immune system from working as effectively as usual. This means thatif you and your healthcare team decide to start and stop treatment, you will still be able to access the treatments again after a significant break, until at least 1 July 2021
  • People with newly diagnosed bowel cancer that has spread to another part of the body, who are either MSI high and/or have deficient mismatch repair genes, will now be able to take a drug called nivolumab or pembrolizumab, instead of chemotherapy
    • Nivolumab and pembrolizumab are immunotherapy drugs that help your immune system find and kill cancer cells
    • They're not yet approved by NICE for bowel cancer (it is currently under review) but is approved for other cancers
    • Using nivolumab or pembrolizumab rather than chemotherapy will hopefully reduce the number of hospital appointments people need, and reduce the chances of people developing neutropenia, which makes them much more susceptible to infections

Based on clinical opinion from members of the Chemotherapy Clinical Reference Group and specialised services cancer pharmacists and endorsed by NHS England and NHS Improvement, each interim treatment change has been clinically assessed against a set of criteria. This criteria includes whether the treatment is less immunosuppressive and so reduces a patient’s likelihood of becoming seriously ill during the coronavirus pandemic, or if the treatment can be administered at home or in a setting that reduces the patient's exposure to coronavirus.

Director of Research and External Affairs Dr Lisa Wilde says: "We're pleased to see the interim treatment guidance will be in place for at least a few more months and that prembrolizumab will also be made available for people with advanced bowel cancer – a patient group with limited treatment options. Clarity of the continuation of this guidance has been the cause of significant anxiety for many bowel cancer patients over the past few weeks."

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