The National Institute for Health and Care Excellence (NICE) does not recommend olaparib (Lynparza) for people with a type of advanced prostate cancer, as the treatment is not deemed cost-effective.
This means that people with prostate cancer with a mutation in the BRCA1 or BRCA2 gene that has spread to another part of the body and that has progressed after a newer hormonal treatment will not be able to receive the drug on the NHS.
This decision will not affect people with this type of cancer currently being treated with olaparib on the NHS unless they and their clinician consider it appropriate to stop.
This decision will be disappointing for people affected by this type of advanced prostate cancer. Evidence has shown olaparib can give people more time before their disease gets significantly worse and can help maintain some patients’ quality of life better than chemotherapy.
Rose Gray, Head of Policy Development at Cancer Research UK
What is olaparib?
1 in 400 people in the UK have the BRCA1 or BRCA2 gene mutations, both of which are associated with an increased risk of developing prostate cancer.
Olaparib is a type of targeted drug called a PARP inhibitor that is used to treat several types of cancer.
PARP is a protein that helps damaged cells to repair themselves. Some cancer cells rely on PARP to keep their DNA healthy. This includes cancer cells with a change in the BRCA genes.
Olaparib stops PARP from repairing DNA damage, which kills the cancer cells.
It is used as a treatment for a number of cancers, but for prostate cancer you have it if your cancer comes back while having hormone therapy.
Trial results demonstrate efficacy
The efficacy of olaparib in people with this type of prostate cancer was previously demonstrated in a late-stage clinical trial.
In the trial, patients taking olaparib lived without their cancer getting any bigger for an average of 7.4 months, in comparison to 3.6 months for those taking existing treatments, in this case either abiraterone or enzalutamide.
However, it was noted in NICE’s decision that re-treatment with abiraterone or enzalutamide used as the control treatment in this trial is not standard care in the NHS.
Standard treatment for patients with this type of cancer who have previously been treated with hormone therapy is a type of chemotherapy drug called a taxane, like docetaxel or cabazitaxel.
The efficacy of olaparib has not been directly compared with the efficacy of these drugs. Therefore, whether it increases survival more than standard treatments is uncertain.
Treatment is not cost-effective
The decision states that whilst olaparib likely meets NICE’s criteria for a life-extending treatment at the end of life, current cost-effectiveness estimates for olaparib are higher than what NICE normally considers an acceptable use of NHS resources.
However, there is an option for NICE to consider the drug for approval again through its rapid review process, whereby olaparib could be reviewed again under a revised price.
NICE decisions are usually adopted in Wales and Northern Ireland as well as England, so the decision is likely to affect patients in all 3 nations, however the drug was approved by the Scottish Medicines Consortium for use in Scotland in October 2021.