There was new hope for Scottish patients with prostate cancer this week after cost regulators approved funding for the use of Ferring's Firmagon on the National Health Service.

Ferring's Firmagon (degarelix) is a gonadotropin-releasing hormone (GnRH) antagonist approved in Europe for the treatment of adult male patients with advanced hormone-dependent prostate cancer. 

The drug has a distinct mechanism of action different from other commonly used hormonal therapies, blocking GnRH receptors in the pituitary gland to suppress luteinising hormone and thereby decrease production of testosterone - which is necessary for prostate cancer growth - by the testicles.

The Scottish Medicines Consortium notes that clinical tests have shown Firmagon to induce a rapid and sustainable drop in both testosterone and prostate specific antigen (a surrogate marker for tumour activity levels), and without an initial surge in testosterone following administration, thereby eradicating the need for short-term treatment with an anti-androgen and reducing the burden on patients. 

And according to Ferring, data from a pivotal Phase III study show a significant cut in the rate of PSA failure or death in patients taking Firmagon compared with the luteinising hormone releasing hormone (LHRH) leuprorelin, particularly in patients with high levels of PSA at the start. "This means that, compared with leuprorelin, treatment with Firmagon may delay the need for additional, later-stage treatments such as chemotherapy, which can be intensive and costly," the firm said.

Cost effective with PAS

The cost watchdog has ruled that Firmagon is indeed a cost-effective use of NHS resources when taking into account a patient access scheme, under which the drugmaker offers its product at a discount. When the PAS was included in its cost model, Firmagon was associated with savings of around £2,641 compared with the LHRH agonist goserelin, and the SMC stressed that its acceptance of Ferring's drug is dependent on the continued availability of the scheme.

News of the SMC's decision has been broadly welcomed by both patient groups and the medical community. "For all men suffering from advanced hormone dependent prostate cancer to now have access to a drug that negates the need for anti-androgen drugs and their possible side effects, will be a terrific improvement,” noted Rob Banner, Director and Trustee of Prostaid.

And John Anderson, a consultant urological surgeon in Sheffield, said Firmagon "offers an additional beneficial treatment option for men with prostate cancer, and may be a preferable choice to surgical castration for many men as it mimics surgical castration more closely than current medical based castration therapies.”