PRESS COMMENT: The National Institute for Health and Care Excellence (NICE) has today published its final guidance on the use of enzalutamide for men with advanced prostate cancer in England and Wales on the NHS.
We welcome the fact that it will now be available for men who have already been treated with the chemotherapy drug, docetaxel. However, the guidance does not cover access for men who have already had abiraterone, and the charity has learnt that NHS England have interpreted this to mean that they do not have to fund enzalutamide for these men. Similarly they will not be funding abiraterone for men who have already had enzalutamide.
The Cancer Drugs Fund is currently reviewing whether it will be funding enzalutamide for men who have had abiraterone in England and vice versa, but the decision around this is yet to be confirmed.
Owen Sharp, Chief Executive of Prostate Cancer UK said: “We are extremely disappointed that NHS England has interpreted NICE’s guidance to mean that they are not obliged to fund enzalutamide for men who have had abiraterone. We have heard many heart-breaking stories of men and their families now left with nowhere to turn, with some resorting to raiding their savings or fundraising to pay for enzalutamide privately.
“The system has given with one hand and taken with another, cruelly snatching away once again a last hope of extra time with loved ones. As these drugs are both relatively new there is not currently a huge volume of evidence to prove the efficacy of sequential use. However in this situation the default position should not be to deny access. Doctors should be enabled to prescribe whichever drugs they feel clinically appropriate and learn from the outcome, without having to worry that their decision may mean another door is closed further down the line.
“The imminent Cancer Drugs Fund decision around sequential use of these drugs is now absolutely crucial, as it is the final hope left for these men in England who have had abiraterone to be able to access enzalutamide. We urge them to do the right thing for men.”
Notes to Editors
- NICE’s guidance applies in England and Wales and is normally also followed by Northern Ireland. Local areas have three months from 23rd July to implement it.
- In England, enzalutamide and abiraterone are commissioned by NHS England Specialised Services, and not by local clinical commissioning groups. NHS England have said they will not fund sequential use of these drugs unless the CDF approves it.
- The Scottish Medicines Consortium approved enzalutamide on the NHS with no reference to a restriction around sequential use.
- The Cancer Drugs Fund only applies to England, and is a time-limited fund intended for drugs that have been rejected by NICE or are awaiting NICE approval.
- The restriction around the use of enzalutamide after abiraterone does not apply to those men who have had to be taken off abiraterone as a result of toxicity issues
- The manufacturer – Astellas - estimate that 3,000 men could benefit from the approval of enzalutamide however Prostate Cancer UK has heard from clinical contacts that as many as 40% – 70% of this patient estimate will not be able to access it due to previous treatment with abiraterone. It should be stressed that these are only estimates as there is no verified data to base this on.