NICE reviews guidance on ovarian cancer

Five ovarian cancer treatments are being reviewed by UK health watchdog the National Institute for Health and Care Excellence (NICE) to ensure the NHS continues to offer the most cost-effective medicines to women.

NICE is considering whether or not the drugs gemcitabine, paclitaxel, pegylated liposomal doxorubicin hydrochloride (PLDH), topetecan and trabectedin should be recommended as treatment options for ovarian cancer that has returned after previous treatment with chemotherapy (recurrent disease).

Sir Andrew Dillon, NICE chief executive, said: “Ovarian cancer is one of the most common cancers in women and for the majority of these people, their cancer will return within two years of finishing treatment.

“These women, just like all other patients within the NHS, deserve access to treatments that will make the greatest difference to their lives and that the NHS can afford.”

In final draft guidance, NICE says that paclitaxel and PLDH are cost effective and should continue to be recommended for routine NHS use.

The draft guidance also recommends the treatment PLDH in combination with platinum chemotherapy, a use for which it is not currently licensed. As it has been shown to be one of the two most effective treatment options for recurrent ovarian cancer, special agreement from the Department of Health was obtained to allow the Institute’s Appraisal Committee to develop this recommendation.

However, the drugs gemcitabine, topetecan and trabectedin were shown to provide less benefit to patients than other options when the disease recurs for the first time at least six months after first-line platinum-based chemotherapy. NICE does not recommend them at this stage of the disease.

The Appraisal Committee did not make any recommendations on using these drugs for treating ovarian cancer at later stages because there was no evidence on which to base an estimate of clinical and cost effectiveness.

For women with ovarian cancer that has not responded to platinum-based chemotherapy or that has recurred within six months of such treatment, the Committee concluded that both PLDH and paclitaxel could be recommended for use, but that topotecan was not cost-effective.

Sir Andrew added: “These recommendations have been developed according to the best available evidence from the manufacturers, an independent assessment group, health professionals and patient organisations.

“The manufacturers and other organisations who are registered stakeholders for this appraisal can appeal against any of these recommendations, but only if they believe NICE has either acted unfairly or exceeded its powers. Otherwise, this draft guidance will proceed to publication next year.”

Ovarian cancer is the fifth most common cancer among women in the UK. In 2011, 6,356 women in England and Wales were diagnosed with the disease. About one-third (35 per cent) of adults diagnosed with ovarian cancer in 2010-11 in England and Wales are predicted to survive for at least 10 years.

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