National Assembly for Wales

Inquiry into the progress made to date on implementing the Welsh Government’s Cancer Delivery Plan

Evidence from Dr Gianfilippo Bertelli– CDP 37

I would like to contribute to the inquiry into progress made to date on implementing the Welsh Government’s Cancer Delivery Plan.

As a Medical Oncologist treating breast and ovarian cancer, I am concerned that I am often unable to offer my patients the same level of care that they would receive in England, due to lack of access to a number of new drugs which are currently routinely available to English patients through the National Cancer Drug Fund. Specifically, pertuzumab, trastuzumab emtamsine, eribulin, everolimus can only be used in exceptional cases in Wales through the IPFR mechanism. If, for these drugs, there is at least equality of inaccessibility throughout Wales, for two other agents - bevacizumab and fulvestrant – restrictions vary in different health Boards.

I understand that other Welsh oncologists are also responding to the inquiry to express their frustration, which I share.

In addition to these clinical concerns, in my role of South Wales Cancer Network Clinical Lead for Research and Trials, I have concerns about the potential negative impact on recruitment in clinical trials resulting from the lack of access to new drugs. Our ability to engage in high-quality clinical research may be compromised because of the following reasons:

- If treatment pathways in Wales continue to diverge from national standards, our patients will become ineligible to participate in multicentre clinical trials of newer agents because their previous or control treatments are not of the standard required by the study protocols.

- Welsh oncologists will fail to gain sufficient experience in the use of modern drugs, with detrimental effect on our ability to train and retain world-class investigators.

- Welsh patients and clinicians will become more reluctant to participate in research, if the results of the trials that they are supporting – i.e., new, more effective drugs – eventually only benefit people living elsewhere.

I hope therefore that the inquiry will lead to a review of the current restrictions.

Yours Sincerely,

Gianfilippo Bertelli

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Dr Gianfilippo Bertelli

Consultant/Honorary Senior Lecturer in Medical Oncology

ABM University Health Board

Singleton Hospital

Swansea