A life-extending prostate cancer drug has been denied to 7,000 men because it is not deemed to be ‘value for money’.
Abiraterone has been hailed as one the greatest achievements in the NHS’s 70-year history for its success in treating advanced prostate cancer.
Costing £2,700 a month, it is one of the few drugs available to men with very advanced tumours and has doubled average survival times.
But it has been rejected by Nice, in draft guidance, due to a lack of evidence over whether it was more effective than existing treatments.
The rationing body also said it couldn’t guarantee that the drug offered ‘value for money’ for the NHS.
Abiraterone has been hailed as one the greatest achievements in the NHS’s 70-year history for its success in treating advanced prostate cancer
Cancer doctors and charities said the decision was ‘concerning’ and ‘disappointing’ and urged Nice to review the very latest evidence.
The drug could have been offered to up to 7,000 men in England a year with an aggressive form of prostate cancer which has spread to organs such as the liver, kidneys and bones.
A major French study last year involving 1,200 men last year showed that it doubled average survival times.
Men given abiraterone lived for an average of 33 months – nearly three years – compared to 14.5 months if they were given hormone treatment.
But the issue is complicated because men in the UK with this type of prostate cancer are given hormone treatment and chemotherapy.
As the French study did not compare abiraterone with chemotherapy, Nice cannot determine whether it is any better.
Doctors who have been using the drug for years – in trials -are certain the drug is more effective than chemotherapy – and causes far fewer side effects.
And many men cannot tolerate chemotherapy, particularly if they are frailer or more susceptible to its side effects which include severe infections.
Professor Paul Workman, chief executive of The Institute of Cancer Research, London, said: ‘Abiraterone has been a game changer for treatment of prostate cancer – extending the lives of men with the disease, and crucially sparing them the side-effects of conventional chemotherapy.
‘I am disappointed that men with advanced prostate cancer will not be able to access abiraterone as a first-line treatment.
‘It is particularly concerning that some men who are ineligible for the current first-line treatment, docetaxel (a type of chemotherapy), should be denied access to abiraterone – and I would urge NICE to consider availability of the drug for these patients as a matter of urgency.’
Tim Windle, policy manager at Prostate Cancer UK said: ‘For some men diagnosed with advanced prostate cancer, treatment with abiraterone alongside hormone therapy has been shown to have impressive results.
‘It is therefore disappointing that this draft decision from Nice is not to approve its use for any of this group. Currently the best treatment available at this stage is chemotherapy alongside hormone therapy, which some men – through no fault of their own – are unable to tolerate. It’s imperative that these men are able to access abiraterone as an alternative.’
Nice’s draft guidance states that abiraterone cannot be used as a ‘first-line’ treatment. This means that it can only be offered to men who have tried hormone therapy and chemotherapy first, for several months, without success.
Many men will not be able to tolerate chemotherapy for several months however.
Prostate cancer affects 1 in 8 men and there are 47,700 new cases in the UK a year.
Approximately 15 per cent have this very aggressive, advanced form
Abiraterone works by blocking an enzyme which in turn stops the body producing the hormone testosterone.
Prostate cancer tumours need testosterone to grow, so stopping the production of teststeonr halts or even reduces its spread.
It was developed in 2008 by doctors at the Royal Marsden, a leading NHS cancer hospital in South West London and the Institute of Cancer Research, also in London.
In January it was approved by the European Medicines Agency, the drugs watchdog, and countries across Europe were encouraged to use it as a ‘first line’ treatment.
Charities are urging the Belgian-based manufacturer Janssen to lower the price.
Last June, a highly promising breast cancer drug was made available on the NHS after the manufacturer Roche agreed to significantly reduce its cost.
Kadcyla had proven to be extremely successful for women with advanced breast cancer and had enabled them to live an extra six months.
Nice and NHS England announced they had persuaded another firm MSD to slash the price of a lung cancer drug so it could be offered on the NHS.
A Nice spokesman said: ‘We understand that some men with prostate cancer will be disappointed by this news.
‘However, we can only recommend drugs that are clinically effective and show value for money compared to current treatment options. In this case, abiraterone has fallen short.
‘This publication is not our final recommendation, it is a draft decision. We hope to receive further information from consultees, including the company, during the consultation period.’