Ali Wheatland is living on borrowed time. The 35-year-old has cervical cancer that has spread to the glands in her pelvis.
Last year doctors told her she had run out of options. The only thing they could offer was gruelling chemotherapy, combined with another drug – which is unlikely to keep her tumours at bay for much longer. Yet if Ali, a charity worker from Torquay, Devon, lived at the opposite end of the UK, she’d be granted a glimmer of hope.
Last week health chiefs in Scotland approved the immunotherapy drug pembrolizumab for use in patients with advanced cervical cancer who no longer respond to other treatments.
The drug, which helps the body’s fighter cells to find and destroy tumours, is used widely in other cancers, including lung, skin, breast and bowel. Recent studies show it can extend the life of cervical cancer patients by an average of eight months – but it’s not available in England.
Ali says: ‘We don’t know when the chemo will stop working – when it does I’m all out of options.
‘Yet, I could move to Scotland tomorrow and get pembrolizumab. It seems so unfair.’
OUT OF OPTIONS: Ali Wheatland, 35,m whose cervical cancer has spread
Now campaigners are calling for the rest of the UK to have access to it. Kate Sanger, head of policy at cervical cancer charity Jo’s Trust, says: ‘Pembrolizumab should be available to all eligible patients across the country.
‘Health chiefs are denying thousands of women the chance to not only live longer, but also stay healthier, continue working, looking after their children and contributing to society.’
Huge strides have been made in cervical cancer prevention in recent years. Cases of the disease in British women in their 20s have dropped 87 per cent since 2008. This is largely thanks to a vaccine, offered to girls, which protects against the sexually transmitted infection human papillomavirus (HPV), which causes 95 per cent of cervical cancers.
Jo’s Trust say that while prevention is vital, health chiefs too often ‘disregard’ the 850 patients who die of the disease every year because of ineffective treatment.
‘There is so much talk about prevention – which of course is a good thing – but at the same time you’ve got an entire community of patients who feel they are forgotten about,’ says Ms Sanger.
About 3,000 Britons are diagnosed with cervical cancer every year, most of whom are in their 30s.
Up to eight in ten people will be infected with HPV at some point in their lives, and it is usually harmless. But 14 of the 150 strains can, in some cases, invade the genital tract where it causes cells to mutate and turn cancerous.
Girls aged 12 or 13 have been vaccinated against these strains of the HPV virus since 2008, and boys of the same age since 2019. It’s hoped this will mean the generations to come are all but immune to cervical cancer. However, women now aged 32 or older missed out on the jab during a catch-up programme for then 18-year-olds.
England’s cervical screening programme – a check-up every three years for women aged 25 to 50, and every five years aged 50-64, to look for signs of HPV – is a weapon against the disease, preventing 70 per cent of deaths.
Last week health chiefs in Scotland approved the immunotherapy drug pembrolizumab (pictured) for use in patients with advanced cervical cancer who no longer respond to other treatments
If caught early, cervical cancer can be cured through surgery, radiotherapy and chemotherapy. But when the disease spreads outside the cervix, one in three won’t survive five years.
As well as further chemotherapy, patients will be offered operations to remove cancerous parts of the body, including the womb, ovaries and vagina. If this fails, or the cancer returns, there are few options.
In 2015, a therapy called bevacizumab was approved in England as it was shown to help shrink tumours in this set of patients when given alongside further chemotherapy. But it only extends life expectancy by about three months.
Pembrolizumab, given via a drip in hospital, works by blocking a protein on the surface of the body’s fighter cells called PD-1 that prevents them from finding the cancer. Once PD-1 is deactivated, the immune system can spot diseased cells and attack.
Potential patients will have tests to ensure they are in the two thirds of cervical cancer sufferers who respond to PD-1 treatment.
International trials, published in the New England Journal Of Medicine in 2021, showed that adding pembrolizumab to chemotherapy can slow the growth of tumours and improve overall survival.
Two years after starting the treatment, half of the pembrolizumab group were still alive, compared to 41 per cent of those with chemotherapy alone. While those who had chemo lived for an average of 16 months, patients on pembrolizumab lived up to two years.
‘It might not seem like a huge difference, but, for women who have been told they have no options left, it’s massive,’ says Ms Sanger.
A recent draft judgment by NHS drugs watchdog The National Institute For Health and Care Excellence (NICE) stated the cost effectiveness of the drug was ‘uncertain’. A firm decision is due at the end of next month.
Ms Sanger says: ‘How can you hold back a drug that is proven to keep some people alive?’