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NICE changes mind over access to prostate cancer drug

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Prostate cancer patients have welcomed the decision to give the NHS access to a new drug, which could offer a lifeline to thousands of men currently facing “death sentences”.

The National Institute for Health and Care Excellence today confirmed it would recommend the use of the drug enzalutamide (Xtandi) for treating those with advanced prostate cancer.

In final draft guidance, NICE said it was happy to approve the use of enzalutamide for patients with hormone-relapsed prostate cancer that had progressed following docetaxel chemotherapy.

“Finally this drug is available to improve and prolong life”

Sandy Tyndale-Briscoe

However, the institute was less clear on the use of the drug for people previously treated with another hormone drug called abiraterone.

In an earlier version of the guidance, NICE said it would not approve the use of enzalutamide after abiraterone, a decision which promoted outrage from prostate cancer patients and charities.

After receiving thousands of complaints and looking at new evidence from the drug’s manufacturer, Astellas Pharma, NICE decided to remove the restriction.

However, it stated that while some patients benefited from treatment with enzalutamide after abiraterone, there were “too many uncertainties” when it came to both clinical effectiveness and cost to make “a definitive evidence-based recommendation”.

Enzalutamide costs £2,734.67 for one pack of 112 40mg capsules. Based on a daily dosage of 160mg and a mean length of treatment of 8.5 months, the manufacturer has estimated that the average cost of treatment with enzalutamide, based on the list price, is £25,269.

Prostate cancer charity Tackle welcomed the overall decision to approve enzalutamide, saying it offered a “vital lifeline” to those facing death due to the limited options for treatment if chemotherapy failed.


Tackle and Prostate Cancer UK outside NICE offices with a petition to make enzalutamide available without restriction

“Finally this drug is available to improve and prolong life for those who have been anxiously waiting for several months,” said the charity’s chair Sandy Tyndale-Biscoe.

“Our task is to ensure that the individual oncologists and local commissioners are aware of the effectiveness of enzalutamide whether or not abiraterone has previously been used.”

Professor Alan Ashworth, chief executive of the Institute of Cancer Research in London, said: “We are very pleased that NICE has listened to the concerns

Institute of Cancer Research

Alan Ashworth

we and others have raised, and dropped a controversial restriction on the use of enzalutamide from its draft guidance.

“This change will have an important effect on thousands of men with advanced prostate cancer by allowing them to access both abiraterone and enzalutamide after receiving chemotherapy, and therefore giving them several more precious months of life,” he said.

A final version of the NICE guidance is expected to be published in June.

The Scottish Medicines Consortium issued guidance in November 2013 accepting enzalutamide for use within NHS Scotland.


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