Image: Scanning electron micrograph of a single prostate cancer cell. Credit: Anne Weston, Francis Crick Institute
The Institute of Cancer Research, London, has expressed disappointment that NICE has decided not to recommend olaparib for previously treated, hormone-relapsed metastatic prostate cancer.
It is the latest in a series of instances where it has not proved possible to widen availability of olaparib for additional cancer indications – highlighting the barriers that exist in taking even highly innovative treatments to patients.
First genetically targeted cancer drug
Olaparib became the world’s first genetically targeted cancer drug in 2014 when it was approved for women with ovarian cancer who had inherited BRCA mutations.
In 2019, results from the PROfound trial showed that the drug was effective for some men with prostate cancer too. Patients with prostate cancers who had faulty BRCA2, BRCA1 or ATM genes lived an average of 7.4 months before their cancer progressed, compared with 3.6 months for those who received enzalutamide and abiraterone.
If this decision becomes final, men in England with previously treated, hormone-treatment resistant, metastatic prostate cancer will not be able to access olaparib. In contrast, in September 2021, the Scottish Medicines Consortium (SMC) recommended the use of olaparib for Scottish men with this type of disease.
Scientists at the ICR were the first to demonstrate that PARP inhibitor drugs, such as olaparib, could be particularly effective in BRCA-mutant cancers.
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Postcode prescribing
Professor Johann De Bono, Professor of Experimental Cancer Medicine at The Institute of Cancer Research, London, and leader of the PROfound trial, said:
“Olaparib is a precision drug that can extend life for men with some mutations in their tumours while sparing them the side effects of chemotherapy. I was delighted when olaparib was approved for NHS patients in Scotland earlier this year – and it’s disappointing that this decision means their counterparts in England and Wales will miss out on such a valuable new treatment option. It’s an example of the barriers that exist to making innovative drugs available at prices that the NHS can afford and is going to result in postcode prescribing across the UK.”
Systemic issues in providing drug access
Professor Kristian Helin, Chief Executive of The Institute of Cancer Research, London, said:
“This is a disappointing decision that will deny men with advanced prostate cancer in England and Wales a personalised treatment that could allow them to live longer and stay healthier. I urge NICE and the manufacturer to come back to the table and try to find agreement on a way to make olaparib available at an agreeable price.
“We must also address the systemic issues we face in providing NHS patients with access to innovative cancer drugs at appropriate prices. The NHS needs to show more flexibility in the way drugs are priced from one indication to the next, to ensure new drugs can reach more patients, and pharmaceutical companies in return must be prepared to offer discounts if drugs do not work as well as promised.”