After a great deal of confusion and what turned out to be an error on my part I wish to let you know that the NICE (The U.K.’s National Institute for Health and Care Excellence) Guidance I shared on the blog on January 28, 2014 (http://advancedprostatecancer.net/?p=4360 ) about enzalutamide (Xtandi) was not accurate.
In my post I indicated that NICE had decided that Xtandi could not be used until a man had failed Zytiga, this was incorrect. The guidance in fact was that Xtandi shouldn’t be given to a man if he has had abiraterone (Zytiga), a different guidance and probably even more devastating to men with advanced prostate cancer.
You can read the full Guidance at: NICE Guidance
The good news is that this is not yet a permanent guidance. NICE is still soliciting opinions and I urge you to reply to this guidance by going to REPLY TO NICE. There is no evidence that Xtandi does not work after Zytiga has failed. Men with advanced prostate cancer should not have a proven medications withheld from them for what seems to be economic reasons.
NICE’s decision to withhold Xtandi after Zytiga failure is not evidence based. If the lack of studies is to be considered evidence then on the same logic NICE should not permit men to have Jevtana (cabazitaxel) after Zytiga or chemotherapy after Zytiga because there is no evidence that this protocol is effective. Clearly, these restrictions make no sense, neither does this horrific possible guidance of no Xtandi after Zytiga.
So, where is the difference? What is really going on?
Joel T. Nowak, M.A., M.S.W.
Hi Joel, I guess I don;t understand, but, are you saying the if you use abiraterone then enzalutamide should not be used ever cause it will fuel the cancer? Begs the question should you just use ensalutamide first? After 10 years I think I am beginnning to become castrate resisitant and need to really think about next steps. Thanks for all you do.
Ron
Ron, No that isn’t what I am saying, I am saying simply that NICE is suggesting that the guidance prohibit enzalutamide if a man has had abiraterone. They argue that there is no evidence that enzalutamide will work if Zytiga has been used since the clinical trial did not include men who had prior abiraterone. There is also no evidence that it doesn’t work. My additional comments, using this logic, were that we should not permit Jevtana if a man has taken either enzalutamide or abiraterone since no clinical trial with Jevtana had any man taking these drugs. You could carry this argument out to say that any man having had Provenge upon become castrate resistant should not get taxotere, abiraterone or enzalutamide. This becomes a mindless argument as is this possible guidance.
I urge anyone (and their families and friends) living in the UK to contact NICE and make comments about this issue.
Joel