NICE, which serves as a cost-effectiveness agency has said in a draft guidance that it supports the use of Xtandi (enzalutamide) in men whose prostate cancer has spread after the failure of first-line therapy (i.e. ADT), but for whom chemotherapy is not yet necessary. The agency found that Xtandi can delay the need for chemotherapy, is well tolerated, and improves survival.  After their review they have determined that Xtandi is an appropriate use of NHS resources, with an incremental cost-effectiveness ration of £34,500 compared to best supportive care.

On the other hand NICE was less impressed with Johnson & Johnson’s Zytiga (abiraterone acetate) turning it down as an option for pre-chemotherapy use by the NHS in England and Wales. NICE acknowledging that Zytiga is well-tolerated and delays the need for chemotherapy, but the committee said it was unsure about the drug’s long-term benefits and calculated its incremental cost-effectiveness ration at between £35,500 and £59,000.

“It is very welcome that NICE has decided that men with prostate cancer can access the drug enzalutamide without having to go through chemotherapy first,” said Prof Paul Workman, chief executive of the Institute of Cancer Research (ICR). However, men will not be able to access Zytiga prior to having chemotherapy, this is despite the fact that Zytiga has already been made available to men with prostate cancer in Scotland at the expense of the NHS.