A prostate cancer drug has been rejected for use on the NHS for a second time, leaving leading scientists disappointed.
The National Institute for Health and Care Excellence (Nice) said it would not recommend abiraterone as a first-line treatment for men with advanced cancer.
Nice first rejected the drug for newly diagnosed patients over a year ago but looked at the matter again in light of an appeal by charities and the manufacturer, Janssen.
The Institute of Cancer Research (ICR) in London, which developed the drug, said it was disappointed by the latest move, which restricts use in England and Wales, while patients in Scotland still have access to the medicine.
What is Abiraterone?
Abiraterone is a type of hormone therapy for men with prostate cancer that has spread to other parts of the body.
It works by stopping the production of the hormone testosterone, which fuels the growth of prostate cancer cells.
The drug is usually only offered to men whose cancer has stopped responding to other types of hormone therapy, but some men have been given it as a first treatment.
Men were also given access to it during the pandemic to prevent needing to take trips to hospital for chemotherapy.
The ICR said another drug recently approved by Nice, called enzalutamide, offers similar benefits to abiraterone but is not suitable for all patients.
It argues that abiraterone is especially important for men unable to tolerate chemotherapy, while two large clinical trials have found that first-line abiraterone extends the time patients live without their disease coming back, halves problems such as bone fracture and the need for radiotherapy and offers them a better quality of life compared with a combination of hormone therapy and docetaxel chemotherapy.
Nick James, professor of prostate and bladder cancer research at the ICR and consultant clinical oncologist at the Royal Marsden NHS Foundation Trust, said: “It’s frustrating that a year and a half after Nice’s initial negative decision and subsequent reassessment, we remain in the same position – with men in England and Wales with newly diagnosed, advanced prostate cancer still unable to access abiraterone at the outset of treatment.
“Abiraterone has clear benefits for helping men with prostate cancer to live longer with a better quality of life, so it is a great shame that patients are being denied the drug on the grounds of cost.
“In the short term, we continue to urge Nice and the drug’s manufacturer to sit down together and agree a suitable price."
Angela Culhane, chief executive of Prostate Cancer UK, said: “It’s really frustrating that after three years of appraisals, abiraterone has been permanently rejected.
“However, thanks in part to campaigning by Prostate Cancer UK and our supporters, most men are now able to access an effective alternative treatment in enzalutamide.
“But with some men still set to lose out on any life-extending treatments, we will continue working hard to make sure they get access to a treatment that works for them.”
Janssen agreed to make abiraterone available to the NHS at a discount but Nice has said the offer is still not not cost-effective.
A Nice spokesman said: “We are disappointed not to be able to recommend abiraterone as further option for treating newly diagnosed high-risk hormone-sensitive metastatic (advanced) prostate cancer.
“However, even with a proposed discount to the price of abiraterone, the cost-effectiveness estimates are higher than what Nice considers an effective use of NHS resources.
“Nice already recommends enzalutamide for high-risk hormone-sensitive metastatic prostate cancer so most people with this condition already have access to an effective treatment.”