There was mixed news for prostate cancer patients in England and Wales after NHS cost regulators endorsed Bayer’s Xofigo but turned down Ferring’s Firmagon.

Xofigo (radium-223) has been recommended in National Institute for Health and Care Excellence draft guidelines for some patients with prostate cancer which has stopped responding to hormone therapy and has spread to the bone.

But the endorsement only extends to patients who have already been treated with docetaxel, and is contingent upon on Bayer providing the drug with a confidential discount agreed in a patient access scheme.

Xofigo is a radio-pharmaceutical agent designed to directly deliver alpha radiation to bone metastases without affecting normal bone marrow. Bayer estimates the average cost for a six-month course with the drug (administered intravenously every four weeks) to be around £24,240.

U-turn on Ferring’s Firmagon

On the downside, the Institute concluded that Ferring’s Firmagon (degarelix) it is not a cost-effective treatment for advanced, hormone-dependent prostate cancer after all compared with the current standard of care. 

Its independent Appraisal Committee had previously provisionally backed the drug’s use in patients with signs and symptoms of spinal cord compression, but clinical experts said that using the treatment at this stage would not be appropriate, explained Carole Longson, director of the NICE Health Technology Evaluation Centre.

“The committee discussed if it could be possible to reliably identify people with spinal metastases who have a higher risk of spinal cord compression. Unfortunately, based on the evidence and inputs from the experts, it concluded that it was not possible to identify the people who may develop spinal cord compression beyond those people with spinal metastases,” she said.