Denosumab

NICE has announced a draft decision not to recommend the drug denosumab (brand name: XGEVA) to prevent complications such as fractures and spinal cord compression in men with advanced prostate cancer that has spread to the bones.

We need more evidence to know what impact this draft decision could have on men across the country.

Tell us what you think

It would be very helpful to hear from anyone with experience of denosumab (XGEVA). We'd also like to hear from anyone who has been prescribed denosumab by their clinician but hasn't been able to access it.

Please email campaigns@prostatecanceruk.org to share your story.

Hearing from you will help us decide how important this issue is to men with advanced prostate cancer and will help us choose what we should say to NICE about this decision. 

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What is denosumab?

Denosumab (XGEVA) is a drug which is licensed for use in preventing fractures and other cancer related bone problems in adults with cancer that has spread to the bones. It works by helping stop bone cells being broken down.

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Why did NICE make the decision not to recommend denosumab?

NICE was looking at whether or not to recommend denosumab (XGEVA) to prevent skeletal-related events such as fractures and spinal cord compression in men with advanced prostate cancer that has spread to the bones.

To decide whether or not to recommend a new treatment for use, NICE compares it with other similar treatments that are currently being used in the NHS. At the moment, the only similar options are bisphosphonates (drugs that prevent the loss of bone mass, such as zoledronic acid) or pain killers and palliative radiotherapy (radiotherapy used to control pain).

In this case, NICE decided that they could not compare denosumab with bisphosphonates because they are not widely used in the NHS. This is partly because the clinical guideline for the treatment of prostate cancer does not recommend bisphosphonates due to a lack of evidence about how effective they are at preventing complications such as fractures.

Therefore, NICE compared denosumab to pain killers and palliative radiotherapy. They decided that the evidence was not strong enough to show that denosumab was more clinically or cost effective at preventing complications so it has not been recommended for use.

NICE accepted that denosumab was found to be effective in reducing pain in some men during clinical trials. However, because denosumab is only licenced forpreventing complications, NICE is not able to recommend it for use in reducing pain.

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What’s the Charity’s view?

NICE made their decision due to a lack of evidence about denosumab's effectiveness. This is disappointing, so we are gathering evidence about this drug and its potential benefits to men.

We know in practice, some men are prescribed denosumab (XGEVA) even though it is not approved by NICE, because health providers are able to choose to pay for drugs even when they are not approved.

We are currently developing a response to NICE's consultation on this draft decision.

To help inform our response, we would like to hear from anyone with experience of denosumab. We'd also like to hear from anyone who has been prescribed denosumab by their clinician but hasn't been able to access it.

Please email campaigns@prostatecanceruk.org to share your story. When you email, please tell us where you live.

Hearing from you will help us determine how important this issue is to men with advanced prostate cancer and will help us decide what we should say to NICE about this decision.