Following a full submission considered under the end of life process, abiraterone acetate (Zytiga) has not been recommended for use within NHS Scotland by the Scottish Medicine Consortium (SMC).

The proposed application of abiraterone was for use with prednisone or prednisolone for the treatment of metastatic castration resistant prostate cancer in adult men who are asymptomatic or mildly symptomatic after failure of androgen deprivation therapy in whom chemotherapy is not yet clinically indicated.

SMC said "The submitting company did not present a sufficiently robust economic analysis to gain acceptance by SMC and in addition their justification of the treatment’s cost in relation to its benefits was not sufficient to gain acceptance by SMC."

The advice took account of the views from a Patient and Clinician Engagement (PACE) meeting.

Comment from the Institute of Cancer Research

Professor Paul Workman, Chief Executive of The Institute of Cancer Research (ICR), London, said:

“We’re very disappointed that Scottish men with prostate cancer will miss out on the chance to have abiraterone much earlier in their course of treatment as a result of this decision. There is clear and growing evidence that use of abiraterone before chemotherapy is beneficial for patients, and gives them longer, healthier lives.

“In its appraisal the SMC acknowledges new evidence showing that abiraterone – which was discovered at the ICR – extends life by an average of more than four months when given before chemotherapy, and much longer than that in some men. But these findings were not included in the cost analysis, and we call for the SMC to consider a new analysis in light of the available evidence.

“Abiraterone maintains patients in a better state of health during the course of treatment than chemotherapy, yet men in Scotland will now have to wait until they are in the final stage of their lives before they can access this treatment, and men who are too frail to receive chemotherapy face not being able to receive abiraterone at all.

“In England, NICE has suspended its equivalent appraisal of abiraterone after initially rejecting it, to allow discussion on price between abiraterone’s manufacturer, Janssen, and the Department of Health.

“We welcome these discussions and urge the parties to do everything they can to reach agreement, so abiraterone can be made available before chemotherapy to men all over the UK who could benefit from it.”

Click here for more on the argument for the use of abiraterone before chemo in prostate cancer.

Source: Scottish Medicine Consortium and the Institute for Cancer Research