It’s yes (but only for some men) to radium-223, but an outright no for degarelix. Sophie Lutter lays out the facts.

10 Jun 2015

Let’s start with the good news. It looks like NICE is preparing to make radium-223  routinely available on the NHS for some men with advanced prostate cancer – those who have already had chemotherapy and whose prostate cancer has spread to the bones.

This is great news for this group of men. Radium-223 can prevent symptoms of bone disease, like bone fractures, and can also reduce bone pain as well as extending life by a couple of months.

But we know that this drug can also benefit men whose prostate cancer has spread to the bones but who haven’t had chemotherapy, and we want NICE to make it available to those men too. And that’s what we’ll be saying in response to this draft decision.

Degarelix: bad news all round

However, NICE’s draft decision looks like bad news for degarelix and very bad news for some men with prostate cancer.

In an earlier appraisal, NICE said that they would make degarelix, a first-line hormone therapy, available to men with advanced prostate cancer who have signs and symptoms of spinal cord compression. This is a serious, but rare, condition where cancer cells grow in or near to the spine and press on the spinal cord. It’s associated with the rapid rise in testosterone that happens when men first take the ‘normal’ type of hormone therapy called LHRH agonists, before testosterone levels start to drop again.

Ferring, the pharmaceutical company who make degarelix, along with Tackle Prostate Cancer and the British Uro-oncology Group (BUG) appealed against this decision.

They said that limiting access to this drug to men with signs and symptoms of spinal cord compression was too great a restriction, and didn’t make any sense because by the time men have signs and symptoms of spinal cord compression, it’s too late for them to receive the benefits of degarelix. There were also problems with the evidence of the drug’s benefits Ferring submitted the first time round – considering how important this drug is for some men, their evidence should have been stronger. There are some men for whom degarelix is a step-change in prostate cancer treatment – men with a heart condition or high risk disease, and men who are unable to have surgery or chemotherapy.

So it’s pretty disappointing that NICE reviewed their decision and have now decided not to make degarelix available to anyone at all. This is because there is confusion around which men would benefit from this drug. NICE’s draft decision is also based on cost as they think degarelix is too expensive.

We’ll be challenging NICE on this decision because we believe they need to do a better job at identifying who will benefit from it. We'll also be calling for the manufacturer to reduce the drug’s cost.

Tailored treatment needs a better appraisal system

We recognise that we’re only talking about a small number of men in each of these cases. But every one of those men still deserves the treatment for his disease that will work best for him, as an individual. Giving men treatment options doesn’t mean that every man will have every treatment. It just means that he and his clinician can choose the treatment that will work best for him.

We know that we can’t treat all men with prostate cancer the same way. And we need a drug appraisal system that recognises that. We need a system flexible enough to deal with this brave new world of tailored treatment pathways. Because at the moment, it’s old-fashioned approach is seriously letting men down.

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