Supporting the

Neuroendocrine Cancer Community

NICE Recommends SIRT Therapy for neuroendocrine tumours

May 16, 2024

We are delighted to share with you the news that NICE has recommended SIRT (selective internal radiation therapy) for the treatment of neuroendocrine tumour-related liver metastases.

NICE Interventional procedures guidance [IPG786]: Selective internal radiation therapy for neuroendocrine tumours that have metastasised to the liver: Published 16th May 2024

What is SIRT and what does this mean for our community?

SIRT is a radiotherapy treatment that targets tumours within the liver, that cannot be safely removed through surgery. It is sometimes also called radio-embolisation or Trans Arterial Radio-Embolisation (TARE). It can be used for primary liver cancers or for cancer that has spread to the liver from another site. For example: liver metastases from a primary bowel neuroendocrine tumour.

The aim of SIRT is to stop or significantly slow the growth of cancer. The additional benefit that may be seen in neuroendocrine tumours, is that it may also reduce some of the hormone-associated symptoms that are caused by the tumours. e.g., Carcinoid Syndrome. SIRT may be performed alone or in combination with other therapies.

It is a local therapy, meaning it only treats cancer cells near where it is administered. When used to target liver tumours, it does not treat other sites of disease outside of the liver.

SIRT (selective internal radiation therapy) takes advantage of the fact that the liver gets its blood supply from 2 sources: the Hepatic Artery and the Portal Vein.

Neuroendocrine Tumours that start within the liver, or have spread to it from elsewhere, get their blood supply from branches of the Hepatic Artery. By using the route taken by the hepatic artery through the liver, to the tumours, this treatment can be more directly targeted.

SIRT involves injecting millions of tiny radioactive beads called microspheres – smaller than the width of a human hair – into the liver blood vessels supplying the tumour. The radioactive microspheres lodge into the micro-vessels supplying the tumour, releasing radiation directly to and through the cancer cells it is made up of.

 

The radioactivity released by each microsphere is limited to target only those cells that are very close to it. This is to help prevent or reduce damage to any local healthy cells. Although the microspheres may remain permanently lodged in place, this does not cause harm to the body: they lose their radioactivity very quickly as it is released through the cancer cells. Most of the radiation from the beads has gone within 2 weeks.

The range of radiation from the beads is very small. But as a precaution, you may be given information in terms of self-care and close contact with others. The advice about this can vary slightly between hospitals. So we would advise you to follow the instructions from your own specialist team, especially the experts that have given you this treatment.

The SIRT team at Oxford – have provided 2 information videos – available on YouTube:

 

What does this news mean for our community?

“It means that certain members of our community will now have access to a treatment that could positively impact on both the control of their disease and their quality of life.”Nikie Jervis, Support Service and Education Lead at Neuroendocrine Cancer UK

“It’s great news . . .I have to say, submitting evidence to NICE for treatment review and approval can be quite nerve-wracking, you have to be able to be as clinically accurate as possible, but you also want to do your absolute best in representing the lived experience of those for whom the treatment would benefit,. . .especially when you have seen the real difference a particular treatment can make.

Prior to its NHS use being restricted almost a decade ago, I saw the clinical and real-life benefits SIRT brought to those living with neuroendocrine liver metastases.

We, as both a patient and HCP community, have seen this borne out, through subsequent clinical trial and global real-world experience.

I am, therefore, delighted to see it now recommended for the treatment of those living with neuroendocrine tumours. But more work is needed to ensure equitable access and funding”

 

Layla Stephens, who is living with neuroendocrine tumour, and is also CEO of our fellow charity PLANETs, has been quoted in today’s Independent:

“SIRT has always been a treatment that has been out of reach for me as it had not been offered within the NHS. . . so this is a major step forward for NET patients who, until now, have only had access to this treatment privately”

Further information on SIRT and other treatments – and our advocacy & campaigns work – for those diagnosed with Neuroendocrine Cancers can be found on our website: www.neuroendocrinecancer.org.uk

ADDENDUM:

PLEASE NOTE: Unlike a Health Technology Appraisal (HTA), there’s no legal requirement to follow the recommendations NICE Interventional Procedure Guidance (IPG) makes. But it’s considered best clinical practice for the NHS to do so.

This does mean that even if NICE issue an IPG recommending an interventional procedure, the NHS is not obliged to provide it.

“Commissioners and/or providers have a responsibility to implement the guidance, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations.”