According to an article this morning on the PharmaTimes web site, Astellas has convinced the National Institute for Health and Care Excellence (NICE) to recommend coverage of enzalutamide (Xandi) in chemotherapy-naive, metastatic, castration-resistant prostate cancer (mCRPC).
By comparison, NICE is not currently recommending coverage of abiraterone acetate (Zytiga) in the same clinical use in the new set of draft guidance, although both products have been approved for such use in the European Union.
Since this set of recommendations is currently only a draft as opposed to a final set, the final recommendations may change, but clearly Astellas appears to have been able to make a more compelling case to NICE than Johnson & Johnson.
Filed under: Living with Prostate Cancer, Treatment | Tagged: abiraterone, coverage, enzalutamide, NICE, UK, Xtandi, Zytiga |
THE "NEW" PROSTATE CANCER INFOLINK 
I’m not surprised based on the oncology. But other factors are the cognitive issues that have been associated in a class of patients on enzalutimade and also the cortical steroid usage with Zytiga. I would never take this proposal as a “one approach covers all patients.” In fact there are reasons that one drug may be a better choice over the other based upon the patient experience and circumstances.
Tony:
I suspect that the NICE decision has a lot more to do with relative cost and “value” than it has to do with relative efficacy and safety.
Mike
Both Xtandi and Zytiga have obviously excited the prostate cancer community. In 2013, Dr. Mark Moyad, serving as interlocutor for the 2013 Conference on Prostate Cancer, asked the three oncologists who addressed advanced disease what drug they would choose if they had prostate cancer and were on a desert island. Here are their answers:
Dr. Charles Myers — a toss up between Zytiga, which acts rapidly, and Xtandi, which is “much safer.” (Minute 48’19 of his talk and questions)
Dr. Nick Vogelzang — three classes of drugs. (Minute 51’45 of his talk and questions)
Moyad asked for a ranking:
— First – Cabozantinib
— Second – Alpharadin [Xofigo]
— Third – a toss up between Zytiga and Xtandi
Dr. Charles Drake — Xtandi (Minute 49’28 of his talk and questions)
Dr. Moyad asked the same question only to two oncologists. Dr. Maha Hussain, who as a woman would be speaking for a mate, and she answered “wine.” She had talked with enthusiasm about all the new drugs. Dr. Mark Scholz responded that he was enthusiastic about all the new drugs.
My impression after studying DVDs of all recent national conferences on prostate cancer is that the nod is to Xtandi among the experts involved in treating many advanced patients, or research as well. Maybe that safety aspect, which Dr. Myers mentioned, tips the scale if you had an artificial situation where you only had to choose one drug, but fortunately we can bring more key facts about the drug and patient to the table in a real situation in the United States as contrasted with England and Wales. I like Tony’s answer, at least for the US, that emphasizes a focus on the particular patient.
Thank you also Sitemaster for continuing to spotlight these instances where the price of treatment is affecting choice of treatment.