NICE says yes to earlier use of Janssen's prostate drug Zytiga

NICE has changed its mind in final guidance and recommended National Health Service funding for Janssen's Zytiga (abiraterone) prostate cancer drug before chemotherapy.

The cost-effectiveness watchdog changed it mind after the company presented new long term survival data and offered to rebate the costs after ten months of treatment.

After rejecting the drug in second draft guidance, NICE has now recommended Zytiga as an option for metastatic hormone-relapsed prostate cancer in people who have no or mild symptoms after androgen deprivation therapy failed and before chemotherapy is indicated.

NICE in 2012 recommended Zytiga in prostate cancer after the disease stopped responding to docetaxel chemotherapy, but was heavily criticised in 2014 by a prostate cancer charity for not recommending the drug in use before chemotherapy.

It has recommended the drug after Janssen offered to rebate the cost from the eleventh month until treatment end, for people who remain on it for more than ten months.

In the decision applying to England and Wales, NICE said that Janssen submitted new evidence focusing on a large group of patients treated with Zytiga in the US. The data showed that 14% of the patients were still taking Zytiga after 4.4 years.

Although NICE's appraisal committee expressed concerns about whether these results could be generalised to the UK, it recognised the new data supported the case for some patients taking the drug for long periods of time.

NICE said that the incremental cost-effectiveness ratio for Zytiga compared with best supportive care would likely fall below its threshold of £30,000 per quality-adjusted life year gained, and it considered it a cost-effective use of NHS resources.

Where NICE recommends a treatment, the NHS is legally obliged to begin funding the drug within three months of final publication date.

Professor Malcolm Mason, Cancer Research UK's prostate cancer expert, said: "Cancer Research UK funded the research that led to the discovery and development of this drug, which was only possible thanks to the generosity of our public supporters, making this a true UK success story. This is a great development for prostate cancer patients."

The decision comes ahead of reforms to England's Cancer Drugs Fund, which from April will pay for oncology medicines if NICE is uncertain about data for up to two years while further cost-effectiveness information is gathered.

England's revised Cancer Drugs Fund to begin in April