The announcement is likely to cause patients who have been diagnosed with bowel cancer enormous distress and anxiety about their future care

Dr Rob Glynne-Jones, Colon Cancer Concern

Bowel cancer is the second most common cancer in the western world and causes around 15,000 deaths in England and Wales each year.

The drugs considered by NICE were irinotecan (trade name Campto), oxaliplatin (Eloxatin), and raltitrexed (Tomudex).

Increased survival rates

Irinotecan, is recommended as a second choice of treatment for patients for whom treatment with another drug, called 5-fluorouracil and folinic acid (5FU/FA), has failed.

Doctors have criticised NICE's for not recommending the combination of irinotecan with 5FU/FA.

NICE said there was insufficient evidence the combination was effective, although doctors said some patients could benefit.

NICE said another drug, oxaliplatin should be the first choice of treatment for patients whose cancer has only spread to their liver and may be operable after treatment, in combination with 5FU/FA.

People will be asking why cancer patients across Europe have access to these drugs while Britons are denied

Cancer Research UK spokesman

It said the evidence showed this treatment could shrink liver tumours enough to allow surgery, and dramatically increase 5-year survival rates from approximately 3% to between 28 to 34%.

But NICE said the combination should not be used as a first choice treatment for patients whose bowel cancer has either spread to anywhere else apart from the liver, or where it is so locally invasive that surgery is unlikely to succeed.

Patients already taking the combinations can continue to do so.

The watchdog said raltitrexed should not be used outside appropriately designed clinical trials.

Weighing up evidence

Professor Peter Littlejohns, clinical director of NICE, said: "This guidance means patients should now have equal access to these treatments wherever they live.

"The Institute's guidance is underpinned by a careful analysis of the evidence balancing clinical and cost effectiveness and we will not recommend a treatment where these criteria have not been satisfied.

"We have recommended use of both irinotecan and oxaliplatin in specific circumstances where cancer patients will benefit.

"But the available data does not support widespread use of these drugs, and they should only be considered in the circumstances specified in the guidance."

A spokesman for Cancer Research UK criticised NICE's decision on the three drugs: "We are puzzled by this latest announcement as the evidence from some of the fifteen randomised clinical trials submitted to NICE appears to show a survival benefit to patients.

"We looked to NICE to help end the postcode lottery but people will be asking why cancer patients across Europe have access to these drugs while Britons are denied."

He added: "If this guidance has been issued to save money we need to know what the financial thresholds are and how these decisions are reached.

Dr David Cunningham of the Royal Marsden Hospital, London, said combination treatments using irinotecan were a key part of bowel cancer care in the rest of Europe and North America.

He added: "The evidence supporting the use of this drug as part of first line treatment is very strong and although it might not be appropriate for all patients, clinicians and patients should have the ability to use the drug if it is deemed appropriate."

Dr Rob Glynne-Jones, medical advisor for the charity Colon Cancer Concern, said: "The announcement is likely to cause patients who have been diagnosed with bowel cancer enormous distress and anxiety about their future care.

"It will be up to charities like ours to reassure these patients already on Campto (irinotecan) combination that this treatment can continue, but how can we then turn around to other patients and say that they can't have the best."

Dr Liam Fox Shadow Health Secretary, said the decision would be "a grave disappointment to the many patients who are suffering and the many charities who are campaigning for improved cancer care."