We call for NHS Scotland and the pharmaceutical company to work together so that ‘decency and common sense can prevail’ after the Scottish Medicine Consortium rejects drug for men with incurable prostate cancer who haven’t had chemotherapy.

10 Aug 2015

The Scottish Medicine Consortium (SMC) has today decided to deny access to the life-prolonging and life-enhancing drug, enzalutamide, for some NHS Scotland patients with prostate cancer. The drug was being assessed for use in men with advanced prostate cancer that no longer responds to hormone therapy, who have not already been treated with chemotherapy.

The announcement follows the SMC’s recent rejection of abiraterone without prior chemotherapy, a drug with similarly life-prolonging and life-enhancing effects for men with incurable prostate cancer. Both drugs have previously been approved for use after chemotherapy.

Today’s decision leaves those men with advanced hormone-resistant prostate cancer, who are unable or unwilling to undergo chemotherapy, without access to a clinically effective treatment and with no other option than symptom relief.

Cruel decision is unacceptable

"The SMC’s decision to deny enzalutamide on NHS Scotland before chemotherapy is yet another intolerable blow to hundreds of men with incurable advanced prostate cancer," says Owen Sharp, our chief executive. "Some men with this type of prostate cancer want the option to delay chemotherapy. Others can’t or don’t want to have chemotherapy at all. Men in these situations need to be given access to the full range of effective treatment options.

"Instead, today’s cruel decision leaves hundreds of men without active treatment and some men with nowhere to turn but palliative care. When effective treatments are on the market but denied to men, this makes the pain all the more difficult to bear."

He adds: "According to today’s announcement only men who are willing and able to have chemotherapy are allowed to routinely access enzalutamide on NHS Scotland. This is unacceptable.

"The SMC and the drug's manufacturer must work together immediately to get this treatment approved, with the manufacturer being clear it is offering the best possible price. The men who need enzalutamide don’t have time to waste. Decency and common sense must prevail as soon as possible."

Situation in England uncertain

South of the border, the picture is still uncertain. Currently, neither enzalutamide nor abiraterone are routinely available before chemotherapy on the NHS in England, although negotiations between NICE and the manufacturer of abiraterone are ongoing and the appraisal for enzalutamide continues.

Men with advanced, hormone-resistant prostate cancer in England can still access both abiraterone and enzalutamide before chemotherapy via the Cancer Drugs Fund (CDF). However, the availability of both drugs is currently being reconsidered because the CDF is overspent and the future existence of the CDF itself is uncertain.

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