Abiraterone: hormone therapy for advanced prostate cancer rejected, limiting options for older men.

The National Institute for Health and Care Excellence (NICE) provides national guidance and advice to improve health and social care. Today they made a decision to reject a targeted hormone therapy that we believe should be available on the NHS at a much earlier stage.

It's vital that this treatment is available for men who are unable to tolerate docetaxel chemotherapy, which is the current standard of care. These men can face the distressing prospect of having no other treatment options available to them. However, this decision will not affect men already receiving the drug, or those who may be eligible to receive it at a later stage of treatment.

Abiraterone works by stopping the body producing a hormone called testosterone. In most men, prostate cancer cells can’t grow without testosterone, even if they have spread to other parts of the body. Many men are already prescribed abiraterone at a later stage of treatment, once they have stopped responding to standard hormone therapies. This will not change, but there is evidence to show that it can be even more beneficial when given to men when they are first diagnosed with high-risk advanced prostate cancer.

Earlier this year, abiraterone became available to men in Scotland with high-risk advanced prostate cancer as first-line treatment, when given alongside hormone therapy.

Then in April, we celebrated our role in securing men’s access to treatments, including abiraterone, that provide a safer, but equally effective alternative to chemotherapy during the COVID-19 pandemic. Unlike abiraterone, which can be taken at home in tablet form, chemotherapy requires several hospital visits and can also affect the immune system, which could put men at risk of the virus. Across the UK, NHS Commissioners took swift action. Abiraterone was made available in Wales and Northern Ireland and was extended to all men with newly diagnosed advanced prostate cancer in Scotland - and not just those whose advanced prostate cancer is high-risk. In England, men can receive enzalutamide and if they cannot tolerate it, they can have abiraterone.

But we can’t be certain how long these arrangements will last and there is a risk that in England, they could come to an end as soon as July.

Heather Blake, our Director of Support & Influencing said, “This drawn-out process has already seen up to 4,300 men miss out on around 15 months of additional life simply because they cannot tolerate the side effects of chemotherapy. It also unfairly denies men in England, Wales and Northern Ireland access to a treatment which is already available in Scotland.

We need a long-term solution so that men can continue to access these life-saving treatments. This is particularly important for older men, that data shows haven’t been receiving chemotherapy. Without this, NICE will be embedding even more inequality into our healthcare system.”

Our appeal: look at the evidence

In their appraisal document, NICE said they’ve struggled to establish the criteria to identify the men who might benefit from receiving abiraterone. But data from Public Health England that we analysed earlier this year shows that older men are often unlikely to receive docetaxel chemotherapy, and therefore may benefit from abiraterone. While 64% of men under 70 are able to tolerate chemotherapy, once a man is over 70, this drops to 22% and goes down only 6% in men over 80. Often these men have other conditions that make chemotherapy unsuitable. There is now evidence to suggest that abiraterone causes substantially fewer adverse side-effects and could be much better tolerated by these older men.

We want NICE to use this data and evidence to reverse their decision. By not making abiraterone available to older men they are creating a health inequality that is denying these men, in the nations outside of Scotland, the opportunity of at least 15 months of additional life. 

Docetaxel if you can

With a range of emerging new treatments for newly diagnosed advanced prostate cancer. it can be difficult to know which treatment is best. None of the treatments have been directly compared with each other, but existing trials indicate that they all have a similar survival benefit.

We believe that chemotherapy is the best option for men who can tolerate it, but for those who can't, we want abiraterone to be an option. We want NICE to review their decision in line with the clear evidence of the potential benefit to these men. We’ll continue to appeal this decision and do everything we can to make sure men get access to the best possible treatments.

If you have concerns about your treatment you can talk to our Specialist Nurses on the phone, webchat or email.