Prostate cancer drug rejected

30th September 2011 - Medication that can extend the lives of men with advanced prostate cancer should be rejected for use in the NHS, the National Institute for Clinical Excellence (NICE) says in draft guidance.

NICE said that cabazitaxel (Jevtana), in combination with prednisone or prednisolone, was not cost effective as a second line treatment after hormone therapy. It said that, despite trials showing cabazitaxel was effective, it was also concerned about the medication's side effects.

High cost

Each cycle of treatment with cabazitaxel costs approximately £3,700, with average costs per patient estimated at £22,200.

Commenting on the recommendations, Sir Andrew Dillon, Chief Executive of NICE said that the appraisal committee was concerned about the effects the medication might have on patients' hearts and renal systems.

Dillon said NICE was also cautious about some of the quality of life information provided by the manufacturer, Sanofi-Aventis; in particular, a study showing that cabazitaxel extended patient life by approximately ten weeks.

Extending life

"The committee also felt that the treatment did not meet the criteria to be considered under NICE's special arrangements for end of life, as based on the current data the length of the life extension could not be considered robustly proven to be at least three months," Dillon said in a statement.

He continued: "Once all these factors had been taken into account it was estimated that the cost per QALY [quality adjusted life year] would be more than £89,000. Therefore the committee concluded that cabazitaxel would not be a cost effective use of limited NHS resources."

'Disappointed': Charity

The Prostate Cancer Charity said it was disappointed by the draft guidance and would be campaigning to get NICE to change its recommendation. It also called on the manufacturer to supply new quality of life information to the committee.

Owen Sharp, the charity's Chief Executive, said in an emailed statement: "Cabazitaxel is an important treatment, only recently licenced for use here in the UK, which can help to extend the lives of men in the final stages of prostate cancer for whom existing treatments have stopped working. These men currently have very few treatment options open to them when their cancer reaches this advanced stage.  Increasing the number of treatments that may extend the lives of these men and allow them to spend precious time with their families is essential.

“We believe that every man with prostate cancer must be able to access any licenced treatment for the disease, if their doctor believes it will be beneficial. It is disappointing to see that NICE does not believe that cabazitaxel is a treatment it can recommend at this stage."

Pending final guidance from NICE, it is up to local health authorities to make funding decisions on whether to use cabazitaxel. GPs could also apply for the medication through the Government's Cancer Drugs Fund.

Cancer care: 'At crossroads'

The decision by NICE comes after a study commissioned by The Lancet Oncology Commission warned that new medicines and surgical techniques for dealing with cancer, along with rising demand, meant that the ability to deliver affordable cancer care in developed nations was "at a crossroads". 

The authors, led by Professor Richard Sullivan of King’s Health Partners Integrated Cancer Centre, London, suggest that careful consideration should be made about the cost of giving dying cancer patients toxic medication and offering them "false hope" associated with such treatment.