NICE decision on enzalutamide and abiraterone without chemo a mixed result

After more than a year of back and forth between NICE and drugs manufacturers, a decision about routine access to two advanced prostate cancer drugs, abiraterone and enzalutamide, without prior chemotherapy is finally in sight.

NICE have announced today that enzalutamide will be routinely available on the NHS in England and Wales, regardless of whether or not a man has previously been treated with docetaxel chemotherapy. Meanwhile, NICE also announced a draft decision not to make abiraterone routinely available without prior chemotherapy.

This appraisal process – for abiraterone at least – has taken over a year so far, and yet the manufacturers of the drug have still not been able to provide NICE the evidence they need to be convinced of its worth.

On the other hand, enzalutamide’s manufacturer made a clear case for the benefit of this drug and made it affordable to the NHS, so men will now have routine access to this life prolonging, and life enhancing treatment.

Different situation north of the border

Men north of the border have been able to routinely access abiraterone without any requirement for prior chemotherapy since October. Enzalutamide is still going through the SMC’s appeal process after an initial rejection.

Heather Blake, Director of Support and Influencing at Prostate Cancer UK said: “Today’s announcement approving earlier use of enzalutamide in England and Wales is a huge victory for men. It shows that when manufacturers finally get their act together and demonstrate clinical benefit at a price the NHS can afford – men can get access to treatments.

"By contrast, it is baffling that after years of negotiation, abiraterone’s manufacturer still hasn’t convinced NICE of its worth as an earlier treatment, which is at odds with what has been agreed for men in Scotland. It is a decision NICE and abiraterone’s manufacturer must step up efforts to change over the coming weeks.

“We can’t carry on with a system that spends more than a year haggling over drugs that could benefit men immediately. We’ve long been calling for wholesale reform of the way cancer drugs are appraised that provides a better deal for patients. Now a proposal is finally on the table we won’t rest until we know it will result in a more streamlined, financially sustainable, fast track process that men and their families so desperately need. Men with advanced prostate cancer do not have time to wait around.”