‘Revolutionary’ prostate cancer drug rejected for use on NHS

A prostate cancer drug has been rejected for use on the NHS, as experts condemned the “disappointing” decision that will deny patients access to the “revolutionary” treatment.

Clinical trials have shown that people taking olaparib (also called Lynparza) have more time before their disease gets worse and live longer overall compared to other treatments.

Scientists have called on NHS England to be more “flexible” when it comes to approving innovative treatments.

More than 47,500 men are diagnosed with prostate cancer every year across the UK and around 11,500 die from the disease.

In draft guidance, the National Institute for Health and Care Excellence (Nice) said the evidence around olaparib was uncertain and approving it would not be a good use of NHS funds.

Nice said the list price of the drug is £2,317.50 per pack of 56 tablets (14 days’ supply), with the cost of an average course of treatment being £37,491.

AstraZeneca, which manufactures the tablets, has a private commercial arrangement that makes olaparib available to the NHS with a discount.

The drug was approved for use for certain patients in Scotland last year.

In numbers: Prostate cancer in the UK

In its guidance for England and Wales, Nice said the drug should not be used for men with hormone-relapsed prostate cancer with BRCA1 or BRCA2 mutations that has spread to other parts of the body.

It looked at people who had already had treatment with the hormone therapies abiraterone or enzalutamide.

The current treatment for prostate cancer that has spread and no longer responds to hormone therapy is chemotherapy with docetaxel, cabazitaxel or radium-223 dichloride.

Nice said that clinical trial evidence shows that people taking olaparib have more time before their disease gets worse and live longer overall than people having retreatment with abiraterone or enzalutamide.

However, it said retreatment with abiraterone or enzalutamide is not considered effective and is not standard care in the NHS.

Nice also said it is uncertain how effective olaparib is compared with docetaxel, cabazitaxel, or radium-223 dichloride because there is no evidence directly comparing the medicines.

An indirect comparison suggests that olaparib increases how long people who have had docetaxel live compared with cabazitaxel, but this is also uncertain, the watchdog said.

The Institute of Cancer Research (ICR), London, whose scientists were the first to demonstrate that PARP inhibitor drugs such as olaparib could be particularly effective in BRCA-mutant cancers, said it was disappointed by the news.

Decision will result in ‘postcode prescribing’

Johann De Bono, a professor of experimental cancer medicine at the ICR, said: “Olaparib is a precision drug that can extend life for men with some mutations in their tumours while sparing them the side-effects of chemotherapy.

“I was delighted when olaparib was approved for NHS patients in Scotland earlier this year – and it’s disappointing that this decision means their counterparts in England and Wales will miss out on such a valuable new treatment option.

“It’s an example of the barriers that exist to making innovative drugs available at prices that the NHS can afford and is going to result in postcode prescribing across the UK.”

Professor Kristian Helin, the chief executive of the ICR, said: “This is a disappointing decision that will deny men with advanced prostate cancer in England and Wales a personalised treatment that could allow them to live longer and stay healthier.

“I urge Nice and the manufacturer to come back to the table and try to find agreement on a way to make olaparib available at an agreeable price.

“We must also address the systemic issues we face in providing NHS patients with access to innovative cancer drugs at appropriate prices.”

Professor Gillian Leng, the chief executive of Nice, said the body was also disappointed not to be able to recommend olaparib for these men.

She added: “However, the company’s own economic model demonstrated that the drug does not offer enough benefit to justify the price it is asking.

“We’ll continue working with the company to try and address the issues highlighted by the committee.”

Prostate Cancer UK previously said clinical trial results of the drug show it would be “revolutionary” in the treatment of prostate cancer.

It is estimated that around 100 people with hormone-relapsed prostate cancer would have been eligible for treatment with olaparib.

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