The National Institute for Health and Clinical Excellence (NICE) has issued draft guidance (January 5, 2022) rejecting the use of Olaparib on the NHS for patients with advanced prostate cancer.
Olaparib, which has been shown to be effective in patients with advanced prostate cancer who have specific genetic changes in their cancer cells, significantly delays progression. Data submitted to NICE by the company (AstraZeneca) shows that patients with metastatic prostate cancer that had become resistant to androgen deprivation who received Olaparib, lived without the cancer getting any bigger for an average of 7.4 months, in comparison to 3.6 months for those taking existing treatments (abiraterone or enzalutamide).
The NICE decision is particularly controversial because the drug was approved for use by the Scottish Medicines Consortium (SMC) in October 2021. In Scotland, patients with metastatic castration-resistant prostate cancer and BRCA1/2 mutations who have progressed following prior hormonal therapy are now able to access the treatment. The Scottish decision takes in to account a confidential discount offered by the company to the NHS. In addition, the SMC applied a more flexible approach in its assessment that takes into consideration the small numbers of patients who would be eligible for treatment.
The negative guidance would not affect patients already receiving treatment, who would continue to be able to do so, until they and their NHS clinician considered it appropriate to stop.