Prostate cancer cells viewed under a microscope.Prostate cancer cells viewed under a microscope.

Men with advanced, hormone-sensitive prostate cancer will now have another treatment option in England, following the approval of the hormone therapy enzalutamide (Xtandi).

The National Institute of Health and Care Excellence (NICE) has approved the combination of enzalutamide and androgen deprivation therapy (ADT) for adults with hormone-sensitive prostate cancer that’s spread to other parts of the body (metastatic prostate cancer).

Kruti Shrotri, Cancer Research UK’s head of policy, said the decision was “good news” for those who could benefit from this treatment.

Patients and clinicians told NICE that people with this type of prostate cancer have limited treatment options and would welcome the option of treatment with enzalutamide. This is especially positive for people who cannot have chemotherapy or choose not to have it due to its potential impact on quality of life.”

New options needed

Right now, people with hormone-sensitive prostate cancer that’s spread are treated with either ADT alone or in combination with chemotherapy and steroids.

But some people choose not to have chemotherapy. According to the NICE appraisal, around 2 in 3 people with hormone-sensitive metastatic prostate cancer take ADT alone – either because they’re not fit enough to take chemotherapy or choose not to because of the potential side effects.

Patient experts explained to the NICE committee that people may have no or few symptoms when they’re first diagnosed with metastatic prostate cancer. And some feel that chemotherapy treatment has too big an impact on their quality of life and may choose to take ADT alone, even though the long-term outcomes may be worse.

Clinical and patient experts agreed that new options – like enzalutamide – are needed.

Enzalutamide blocks testosterone from reaching prostate cancer cells, slowing cancer growth. Combining enzalutamide with ADT is a better tolerated treatment than chemotherapy and ADT. And clinical trial results show that it’s more effective than ADT alone, making it a useful alternative.

Enzalutamide is also an oral therapy, so is more convenient to take than the chemotherapy docetaxel, which is administered intravenously.

Improving progression free survival

Two large clinical trials have looked at the effectiveness of enzalutamide and ADT for treating hormone-sensitive prostate cancer that’s spread to other parts of the body.

People taking enzalutamide plus ADT lived without their cancer growing significantly compared with those taking docetaxel plus ADT. But whether the treatment improves survival overall is unclear based on current data

Despite this uncertainty, the treatment was considered cost-effective for use in the NHS by NICE and will now be an option on the NHS in England. NICE decisions are usually adopted in Wales and Northern Ireland as well, so the decision is likely to affect patients in all 3 nations. Scotland has a separate process for reviewing drugs.

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