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NICE rejects hormone drug before chemo for prostate cancer

Disappointment follows draft ruling not to allow NHS access to hormone drug before chemotherapy in prostate cancer patients.

Abiraterone (Zytiga) is a hormone therapy, which stops more testosterone from reaching the prostate gland and thereby stifles the tumour.

The drug, manufactured by Janssen, has previously been recommended by the National Institute for Health and Care Excellence for treatment after docetaxel containing chemotherapy.

“We urge NICE and the drug’s manufacturer to get back to the table”

Paul Workman

However, a current NICE appraisal, which is considering the use of abiraterone before chemotherapy, has not backed the drug.

In final draft guidance published today, NICE rejected the use of abiraterone acetate for the treatment of metastatic hormone relapsed prostate cancer not previously treated with chemotherapy.

NICE chief executive Sir Andrew Dillon said: “Abiraterone is not a new drug, but it is the first treatment of its type to become available prior to chemotherapy.

Sir Andrew Dillon

Sir Andrew Dillon

“We are disappointed not to be able to recommend abiraterone for use in this way,” he said. “However, the manufacturer’s own economic model demonstrated that the drug does not offer enough benefit to justify its price.”

The clinical evidence submitted to NICE by the manufacturer came from one trial. The results indicated that abiraterone could delay the progression of the disease, but NICE said it was not clear how much abiraterone actually extended life.

It also noted concerns with the way the manufacturer calculated estimated cost-effectiveness. The health economic model was “particularly complex”, it said, but it was clear the drug was not cost effective at its current price.

Owen Sharp, chief executive of Prostate Cancer UK, described the situation as a “fiasco”. 

“For many this presented a vital opportunity for extra time with loved ones and a chance to delay chemotherapy and the debilitating side effects which come with it,” he said.  

“An inflexible NICE process plus the drug company’s inability to produce all the requested data has led to this being just the latest in a string of hugely disappointing rulings on prostate cancer drugs,” he said.

“We urge Janssen and NICE to get their act together and do whatever is necessary to get abiraterone pre-chemotherapy across the line without delay.”

ICR

Paul Workman

Professor Paul Workman, interim chief executive of the Institute of Cancer Research in London, which discovered the drug, said he was “very disappointed”

“We urge NICE and the drug’s manufacturer to get back to the table, and explore every option for making abiraterone available to these men at a price that is affordable for the NHS,” he said.

Abiraterone is the second most requested medicine through the NHS Cancer Drugs Fund, according to Janssen.

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