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NICE rejects use of prostate cancer drug olaparib

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The National Institute for Health and Care Excellence (NICE) has rejected the use of olaparib on the NHS for treatment of adults with hormone-relapsed prostate cancer with BRCA1 or BRCA2 mutations which has spread to other parts of the body.

In a draft guidance issued today (January 5) NICE said evidence around the drug made by AstraZeneca was uncertain and approving it would not be a good use of NHS funds.

Current treatment for metastatic prostate cancer that no longer responds to hormone therapy is chemotherapy with docetaxel, cabazitaxel, or radium 223 dichloride — a treatment option for people with symptomatic bone metastases who have already had docetaxel or cannot have it.

NICE said: “Clinical trial evidence showed that people taking olaparib have more time before their disease gets worse, and live longer overall, than people having retreatment with abiraterone or enzalutamide. However, retreatment with abiraterone or enzalutamide is not considered effective and is not standard care in the NHS.

“Also, it is uncertain how effective olaparib is compared with docetaxel, cabazitaxel, or radium 223 dichloride because there is no evidence directly comparing them. An indirect comparison suggests that olaparib increases how long people who have had docetaxel live compared with cabazitaxel, but this is also uncertain.

“Taking all these factors into account, the cost-effectiveness estimates for olaparib are higher than NICE considers an acceptable use of NHS resources, even when the end-of-life weighting is applied.”

It is estimated that around 100 people with hormone-relapsed prostate cancer would have been eligible for treatment with olaparib, a public consultation on the preliminary recommendations of which is available until 31 January 2022.

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