The National Institute for Health and Care Excellence has issued final recommendations endorsing National Health Service use of new therapies for ovarian cancer, multiple myeloma and prostate cancer, but rejecting one for gastric cancer.
AstraZeneca’s Lynparza (olaparib) has won backing as a maintenance treatment for patients with relapsed platinum-sensitive ovarian, fallopian tube and peritoneal cancer.
The drug targets cancers in adults testing positive for the BRCA1 or BRCA2 mutations, and whose disease has responded to platinum-based chemotherapy.
NICE has stipulated that Lynparza should be available for people only if they have had three or more courses of platinum-based chemotherapy, and that its cost for those who remain on treatment after 15 months is met by the company.
Meanwhile, the Institute also recommended Bayer’s Xofigo (radium 223 dichloride) as an option for treating adults with hormone relapsed prostate cancer, but only in those who: have previously received docetaxel treatment; are experiencing symptoms from the disease spreading to their bones; and have no signs of cancer in any other organ.
The drug is a radiopharmaceutical agent that delivers alpha-radiation to cancer that has spread to the bone without affecting the patient’s healthy bone marrow. Its recommendation is also dependent on the patient access scheme discount (PAS) agreed as part of the appraisal.
Bayer previously noted that, if the therapy is removed from England’s Cancer Drugs Fund, Scotland will remain the only country in which NHS patients can access Xofigo before they have been treated with chemotherapy.
Sticking with prostate cancer, Astella’s Xtandi (enzalutamide) was also green-lighted for NHS use to treat metastatic hormone-relapsed forms of the disease in patients who have no or mild symptoms after androgen deprivation treatment has stopped working, and before chemotherapy is needed.
NICE described the drug as “a well-tolerated treatment that delays chemotherapy (which it recognised as being valuable to patients) and improves survival”, found to be cost-effective when provided through the agreed PAS.
Elsewhere, Novartis’ Farydak (panobinostat) can be routinely prescribed as a possible treatment for people with multiple myeloma, if they have had at least two prior therapies (including bortezomib and an immunomodulatory agent).
The decision, which marks a u-turn from an original rejection that was overturned after the consultation process, is conditional on the continued provision of the agreed PAS.
Farydak is the first cancer medicine to target enzymes known as histone deacetylases, offering a novel mechanism of action different from other MM treatments on the market, and was shown in trials to boost progression-free survival by around 7.8 months versus treatment with Velcade/dexamethasone alone.
On the downside, the cost watchdog issued a final ‘no’ for Lilly’s Cyramza (ramucirumab) as a treatment for patients with metastatic stomach cancer or this with cancer that develops at the point where the food pipe joins to the stomach.
The independent appraisal committee concluded that the drug does not provide enough benefit to patients to justify its high cost and did not qualify for end of life considerations.
The most plausible incremental cost effectiveness ratio for Cyramza compared with best standard care was calculated to be £188,100 per QALY gained, so far above normal value for money benchmarks.