NICE restricts availability of prostate cancer drug
28th January 2014 – A health charity has accused the NHS funding watchdog of a "blatant U-turn" after it limited the number of men with prostate cancer who will be eligible for a new life extending medication.
Updated draft guidance from the National Institute for Health and Care Excellence (NICE) says that enzalutamide should be made available on the NHS in England for men with advanced prostate cancer. However, it should not be given to men who have already been treated with an alternative drug, abiraterone.
NICE says that whereas enzalutamide was previously only recommended for people whose disease has progressed during or after one chemotherapy treatment with another drug called docetaxel, this limitation has now been removed and it is now recommended for people whose disease has progressed during or after any number of docetaxel-containing chemotherapy regimens.
The restriction relating to abiraterone was not included in previous draft guidance issued in October 2013 and does not apply to Scotland where men can freely be prescribed enzalutamide following approval last year by the Scottish Medicines Consortium.
New hormone therapy
Enzalutamide, also known by its brand name Xtandi, is a new type of hormone therapy for men with advanced prostate cancer that is no longer responding to exisiting hormone therapy or chemotherapy. Trial data showed that it is capable of extending life by about 4 months.
NICE has defended its recommendations by pointing out that trial data provided by the manufacturer Medivation did not include any men who were given enzalutamide after being prescribed abiraterone. Therefore, it says, it was not able to draw any conclusions about the effectiveness of enzalutamide after previous abiraterone treatment.
'Playing fast and loose'
Prostate Cancer UK is calling on NICE to remove its restriction and is encouraging those affected by prostate cancer to respond to the consultation.
The charity's chief executive, Owen Sharp, says in a statement: "This blatant U-turn is at best disheartening. Adding this restriction to their draft decision, without any explanation, leaves hundreds of men, who have few treatments anyway, with no hope of accessing enzalutamide. The process has been marked by confusion and a real lack of transparency.
"NICE is playing fast and loose with men with prostate cancer in the advanced stages of the disease who may become resistant to other treatments, and what's worse without saying why.
"We will fight this decision for men. That's what we are here for, but it will not help the men who could be benefiting during this delay. We hope they follow the decision made in Scotland, and allow clinicians to make the decisions about what drugs are best for patients."