Today’s approval of the hormone therapy, degarelix, by NICE expands on the decision made in 2014 to make it only available to those men who have already developed the symptoms of spinal cord compression. Now, men whose prostate cancer has spread to their spine and who could be at risk of this condition can also access this treatment.
The National Institute of Health and Care Excellence (NICE) has today approved the hormone therapy, degarelix, for men whose prostate cancer has spread to the spine, which therefore makes them at risk of spinal cord compression. Previously the treatment was only approved for men who already had spinal cord compression. The new approval has been given on the basis that commissioners achieve at least the same discounted drug cost made available to NICE in June 2016.
The decision is great news for men with advanced prostate cancer that has already spread to their spine when they are beginning hormone therapy for the first time. Spinal cord compression (SCC) can occur when a man’s prostate cancer has spread and presses on the nerves in the spine. On average, only 1% of men with locally advanced or metastatic disease will experience SCC. But if a man believes he is starting to develop the condition, it needs to be treated as an emergency as it can have long-term effects on things like mobility and continence if left unchecked.
This decision was appealed because for many men, by the time they experience symptoms, it's often too late for degarelix
Compared to other hormone treatments, degarelix doesn’t lead to an initial rise in hormone levels at the start of use, which can make the situation worse for men at risk of developing SCC. That's why the treatment is so important for men with advanced prostate cancer that has already spread to the spine when they’re beginning hormone therapy for the first time.
Degarelix was initially approved by NICE in 2014, but was limited to men who were already experiencing symptoms of SCC. This decision was appealed because for many men, by the time they experience symptoms, it's often too late for degarelix to benefit them.
Heather Blake, our Director of Support and Influencing, said: "Men whose prostate cancer is so advanced that it has spread to their spine live at risk of their spinal cord being compressed – a serious condition that can be very debilitating. Today’s decision is critical for those men who already have cancer in their spine when they begin hormone therapy treatment, because degarelix is the only one of these treatments which can provide immediate reduction of cancer in the bone and stop this awful condition taking hold.
This final decision has been a long time coming, and we strongly encourage the commissioners and manufacturer to get the necessary agreements in place as swiftly as possible
"This final decision has been a long time coming, and we strongly encourage local commissioners and the manufacturer to work together to get the necessary agreements in place as swiftly as possible, so men in England can start to receive the treatment without delay."
Degarelix first received its European Medicines Agency licence in 2008, for the treatment of adult male patients with advanced hormone-dependent prostate cancer. During a protracted appraisal process, degarelix has been commissioned on an ad hoc basis across England. But today’s decision gives men in England similar access to men in Scotland, ending treatment variations based only on where a man lives.
Degarelix has been routinely available on the NHS in Scotland since its approval by the SMC in 2011. Men whose prostate cancer spreads to the spine after they have already started on hormone treatment will be advised to continue on their current hormone treatment.
According to a recommendation of the All Wales Medicines Strategy Group in 2012, Degarelix (Firmagon®) is recommended as an option for use within NHS Wales for the treatment of men with advanced hormone-dependent prostate cancer. This recommendation applies only in circumstances where the approved Wales Patient Access Scheme is used.
This article and its headline were amended on 8/7/16 to clarify the situation in Wales.