British Men Who Have Had Abiraterone Will Not Get Enzalutamide Despite Its Life Extending Ability
Our brothers in England hit a major snag last week as NHS placed a burdensome restriction on the use of enzalutamide (Xtandi) for men with advanced prostate cancer who have already had abiraterone (Zytiga). Because of this ridiculous decision thousands of men with advanced prostate cancer will be denied this life-extending drug.
The reality is that enzalutamide prolongs life by at least five months in men who have run out of treatment options – with some surviving more than 18 months.
This NHS guidance means men with advanced prostate cancer will only be able to get one of the two new drugs used for advanced prostate cancer; Zytiga or Xtandi – both of which British scientists helped to develop.
Up to 3,000 British men a year would benefit from the use of these new drugs, which have been use for many men either before or after chemotherapy. Until now, The Cancer Drugs Fund and the NHS have funded these drugs while awaiting a decision from the National Institute for Health and Care Excellence (Nice) on whether enzalutamide should be routinely paid for to treat men with castrate resistant prostate cancer.
Initially it was funded, but in January Nice proposed that it should be banned for men in England and Wales previously treated with abiraterone. Men in Scotland are getting it without any of these restrictions.
An outcry over this plan led to Prostate Cancer UK spearheading a campaign to fund enzalutamide, with over 13,500 people signing its petition. The protest also had widespread support from high profile figures such as Sir Michael Parkinson and other organizations such as Tackle Prostate Cancer.
Under this pressure Nice performed another U-turn and in April it went back to its original position of recommending enzalutamide regardless of a man’s previous treatment history.
However, last Wednesday another new contrary guidance from Nice came out that says there is not enough evidence to make a recommendation about how the two drugs should be used. This is true, but the response should not be to restrict either of these drugs. Clearly, this is a pure economic decision.
NHS England, the body which advises local area cancer teams on which drugs to fund, says as a result of the lack of evidence men who have been treated with abiraterone cannot have enzalutamide.
It goes further, saying men who have received enzalutamide cannot then have the other drug, Zytiga – effectively restricting men to only one of these drugs during their treatment, or maybe I should say their now their unnecessarily abbreviated life.
Joel T. Nowak, M.A., M.S.W.
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