The ICR responds to NICE’s recommendation not to approve abiraterone as first-line treatment for advanced prostate cancer


The Institute of Cancer Research, London, is disappointed at the decision by NICE not to recommend abiraterone as a first-line NHS treatment for newly diagnosed, advanced prostate cancer.

NICE first rejected abiraterone as a first-line treatment for newly diagnosed, advanced prostate cancer over a year ago, in June 2020. Four months later, NICE announced it would reconsider its decision. The trial data showing the efficacy of abiraterone in this setting was published in 2017, so this very long process is clearly not in the patients’ interests.

Today, NICE has concluded not to recommend abiraterone once again, leaving men in England and Wales who are first diagnosed with advanced prostate cancer with three options: hormone therapy plus the newly approved enzalutamide, hormone therapy plus docetaxel chemotherapy or hormone therapy on its own. By contrast, men in Scotland have been able to access abiraterone as a first-line treatment since the beginning of 2020.

Like enzalutamide, which was recently approved by NICE, abiraterone offers men a clear improvement in quality of life compared with chemotherapy or hormone therapy alone. Its benefits are especially important for men unable to tolerate chemotherapy.

Abiraterone has also been found to halve the risk of serious complications such as bone fractures and spinal cord problems from cancer when compared with a combination of hormone therapy and docetaxel chemotherapy.

Enzalutamide has similar benefits but is not suitable for all patients and broader choice on this issue would be of benefit.

Professor Nick James, Professor of Prostate and Bladder Cancer Research at The Institute of Cancer Research, London, 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. But this situation also brings into sharp relief the need for innovative and more flexible models of drug pricing for the NHS, which could allow a drug’s price to vary depending on what it is being used for, and to be tied to the outcomes it delivers for patients.”

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