The National Institute for Health and Care Excellence (NICE) is reviewing its guidance on the use of five drugs, to decide whether or not they should be recommended as treatment options for ovarian cancer that has returned after previous treatment with chemotherapy.

NICE is looking at the use of gemcitabine, paclitaxel, pegylated liposomal doxorubicin hydrochloride (PDLH), topetecan and trabectedin in this setting, and in final draft guidance, it says that paclitaxel and PLDH are cost-effective and should continue to be recommended for routine NHS use.

The draft guidance also recommends PLDH in combination with platinum chemotherapy. While PLDH is not currently licenced for this use, this has been shown to be one of the two most effective treatment options for recurrent ovarian cancer, and special agreement from the Department of Health has enabled NICE’s appraisal committee to develop this recommendation.

The draft guidance does not, however, recommend the use of gemcitabine, topetecan or trabectedin at this stage of the disease. They were all shown to provide less benefit to patients than other options when the disease recurs for the first time in at least six months after first-line platinum-based chemotherapy, it says.

The appraisal committee made no recommendations on using these drugs for treating ovarian cancer at later stages because there was no evidence on which to base an estimate of clinical- and cost-effectiveness, it adds. 

For people with ovarian cancer that has not responded to platinum-based chemotherapy or that has recurred within six months of such treatment, the committee concluded that both PLDH and paclitaxel could be recommended for use, but that topotecan was not cost-effective.

“Ovarian cancer is one of the most common cancers in women, and for the majority of these people, their cancer will return within two years of finishing treatment. These women, just like all other patients within the NHS, deserve access to treatments that will make the greatest difference to their lives and that the NHS can afford,” said NICE chief executive Sir Andrew Dillon.

He added that the draft recommendations had been developed according to the best available evidence from the manufacturers, an independent assessment group, health professionals and patient organisations.

‘The manufacturers and other organisations who are registered stakeholders for this appraisal can appeal against any of these recommendations, but only if they believe NICE has either acted unfairly or exceeded its powers. Otherwise, this draft guidance will proceed to publication next year,” said Sir Andrew.