9.3 months against 7.4, and available from today: England's first drug for advanced anal cancer

England’s health technology assessor, NICE, on Thursday recommended retifanlimab (brand name Zynyz, made by Incyte) together with platinum-based chemotherapy for adults with anal canal cancer that has spread and cannot be removed by surgery¹. It is the first time NICE has recommended a drug for this form of the disease, and the treatment is available on the NHS from today¹. About 250 people in England could benefit, NICE estimates¹.

The numbers, plainly. In trials, people given retifanlimab with carboplatin and paclitaxel had on average 9.3 months before the cancer worsened, against a median of 7.4 months with placebo and chemotherapy¹. Average survival was 32.8 months, almost three years, against 22.2 months on chemotherapy alone, with some patients responding for much longer¹. Desk arithmetic: that is about 10.6 months more survival, and about 1.9 months more before the disease progresses, on the trial figures as NICE reports them. Not a cure; more time.

Why it matters beyond the 250. Around 1,600 people a year were diagnosed with anal cancer in the UK between 2017 and 2019, two-thirds of them women, and HPV infection is linked to about 90% of UK cases¹. Once it has spread, only around 20% live five years, against around 90% when it has not¹. That gap is the argument for two dull things at once: earlier diagnosis of a cancer that patient experts told NICE is too little known, and prevention of the infection behind most cases.

The machinery. NICE published its guidance at the same time as the medicines regulator, the MHRA, granted the licence, and says it now publishes guidance for medicines 30% faster than before April 2024¹. The company offers the NHS a confidential discount, and the committee applied a severity modifier of 1.2, which allows a higher cost-effectiveness threshold for severe conditions¹. “Very few new treatments have been invented” for this cancer, said Professor Peter Johnson of NHS England¹. Today, one more was paid for.