Preliminary guidelines from the National Institute for Health and Care Excellence have rejected the use of AstraZeneca’s ovarian cancer drug Lynparza by the National Health Service in England and Wales because it is too expensive, sparking dismay among cancer charities. 

Lynparza (olaparib) is approved as a targeted maintenance therapy for relapsed platinum-sensitive ovarian, fallopian tube and peritoneal cancer in patients who carry BRCA1 or BRCA2 mutations and have previously undergone chemotherapy.

But the cost regulator has ruled that the price the NHS is being asked to pay “is too high for the benefit it may provide to patients”.

“Olaparib slows the progression of the disease for patients with some forms of ovarian cancer but the evidence that it can extend life is uncertain,” noted NICE chief executive Sir Andrew Dillon. “Because patients are already living longer than two years with conventional treatment, we weren’t able to apply the flexibility we can sometimes use when we appraise cancer drugs”, he explained.

AZ’ probable base-case incremental cost effectiveness ratio for Lynparza compared with routine surveillance was estimated at £49,146 per QALY gained, but the Committee felt this was likely to be an underestimate because it didn’t include the cost of tumour testing to identify patients with the non-inherited mutation and probably overestimated the overall survival gain. 

But Peter Johnson, Cancer Research UK’s chief clinician, says the decision is “hard to understand” and warns that the NHS “can’t afford to ignore important innovations like this while our ovarian cancer survival rates lag behind the rest of the developed world”.

‘Frustrating’ delay

Paul Workman, chief executive of The Institute of Cancer Research, London, which worked on the drug’s development, also expressed disappointment with NICE’s decision, arguing that the evidence of Lynparza’s benefit in women with BRCA positive ovarian tumours “is very clear and this frustrating delay will prevent around 450 women each year from being able to access a beneficial treatment”.

“This decision highlights how the current system of drug evaluation and pricing needs reform - in particular to reward the development of innovative drugs that address unmet need in cancer treatment, and which have additional, further potential,” he stressed.