There is some really good news for those of us who live in areas where The National Institute for Health and Care Excellence (NICE) recommends drug approvals. NICE has issued a final draft guidance recommending that men with hormone-relapsed prostate cancer (castrate resistant) that has metastasized and has been treated with docetaxel (chemotherapy) should be given access to Xtandi (enzalutamide), even if they had prior exposure to Zytiga (abiraterone). The prior recommendation did not permit men with prior Zytiga exposure to receive Xtandi.
NICE changed their original guidance, men who had prior Zytiga exposure would not benefit from Xtandi after Astellas provided observations showing that Xtandi worked in a portion of men who had received previous treatment with Zytiga.
Commenting on NICE’s final draft guidance, Professor Carole Longson, director of NICE’s Health Technology Evaluation Centre, noted that Xtandi “is a new drug that works in a different way to the others currently available for treating prostate cancer, and as there are few treatments available for patients at this stage of prostate cancer, we are very pleased to be able to recommend it.”
Earlier, I have written about my serious concerns surrounding some American insurance companies who have begun to use Step Therapy. Step Therapy is the practice when payers refuse to pay for one drug until a cheaper drug with a similar mode of action had been used. Some insurers refused to pay for Xtandi, which is more expensive than Zytiga, but insisted that the doctor use the less expensive drug Zytiga citing that both were hormone-modulating treatments. Yes, they both are hormone-modulating treatments, but their modes of action are in fact not the same. Zytiga prevents the creation of androgens while Xtandi blocks the androgen receptor. These insurance companies need to take their cue from Dr. Longson who clearly understands that their mode of action is not the same. She made this very clear when she commented on the NICE removal of the restriction on the use of Xtandi after Zytiga exposure when she said “(Xtandi) is a new drug that works in a different way to the others currently available for treating prostate cancer.”
This modification of NICE’s recommendation is good news for our brothers as well as provides American doctors with some additional ammunition to support any insurance appeals they may need to make to fight this insidious Step Therapy.
Joel T. Nowak, M.A., M.S.W.
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