In the latest blow to men with prostate cancer, the National Institute for Health and Care Excellence (NICE) has issued a draft decision not to recommend the use of radium 223 on the NHS in England and Wales.
The Scottish Medicine Consortium (SMC) has yet to consider the drug for use in Scotland.
Radium-223 is an internal radiotherapy treatment for prostate cancer that has spread to the bone and is not responding to hormone therapy. The monthly injection has been shown to extend life by an average of 3.6 months with minor side effects and also to delay bone problems, such as fractures and spinal cord compression, by 5.5 months.
In a draft decision that will disappoint many men in the latter stages of the disease, NICE says:
"Radium-223 dichloride is not recommended within its marketing authorisation, that is, for treating adults with hormone-relapsed prostate cancer, symptomatic bone metastases and no known visceral metastases."
However, NICE had little choice in coming to the decision. The NICE Committee concluded that it was not possible to determine whether radium-223 could be considered a cost-effective use of NHS resources, because the manufacturer, pharmaceutical company Bayer, did not provided the appropriate comparison with other cancer drugs, docetaxel and abiraterone.
Mikis Euripides, Director of Policy and Strategy at Prostate Cancer UK said: "It’s a terrible kick in the teeth for men facing their last months, especially as other new treatments, such as enzalutamide, have restrictions on use in England and Wales. Unless the drug company provides the necessary evidence, men will be denied this safe and effective drug. We urge Bayer to submit everything required in the coming weeks before NICE takes its final decision on this valuable treatment. Men dying of prostate cancer have so few options and to lose one that has already been developed and is known to be effective is madness."
Radium-223 is a radioactive substance which is injected into a vein.
It travels around the body in the blood and is taken up by bones that have been damaged by prostate cancer. It kills the prostate cancer cells in the bones, but doesn’t damage many surrounding healthy cells, and so doesn't cause many side-effects.
As well as extending life, radium-223 improves the symptoms of advanced prostate cancer that affect the bones, such as pain and so improve quality of life.
Although it is not currently approved for us on the NHS, it is available in England and Wales on the Cancer Drugs Fund. Read more about the Cancer Drugs Fund.