NICE may decline abiraterone

NICE is not minded to recommend abiraterone (Zytiga) for, in combination with prednisolone, castration-resistant metastatic prostate cancer after failure of docetaxel-based chemotherapy (www.nice.org.uk).

This is the second promising new treatment for castration-resistant metastatic prostate cancer that has not impressed NICE recently: in January, its final appraisal consultation document did not recommend Sanofi’s cabazitaxel (Jevtana).

NICE’s appraisal consultation document (the prepenultimate step before publishing final guidance) does not recommend Janssen’s androgen biosynthesis inhibitor because the cost per QALY gained compared with mitoxantrone (£63 200) was too high when modelled correctly for a UK population – even after Janssen offered a discount via a patient access scheme.

Abiraterone is one of the top five treatments provided through the Cancer Drugs Fund. It has been shown to increase median survival to 14.8 months compared with 10.9 months with prednisolone alone. However, it does meet NICE criteria for special end-of-life consideration because the eligible population is not small. Appeals against this consultation will be considered in March; final guidance is expected in May.