NHS backs olaparib for breast and prostate cancer

A decision today to allow olaparib for NHS patients with both early-stage breast cancer and prostate cancer has been hailed a “life-changing” decision by leading specialists.

The National Institute for Health and Care Excellence today recommended the treatment for early breast cancer and hormone-relapsed metastatic prostate cancer following new commercial deals between NHS England and AstraZeneca.

The successful negotiations mean olaparib is classed as a clinically and cost-effective option after surgery and chemotherapy for adult women with HER2-negative, high-risk early breast cancer who have inherited faults in their BRCA1 or BRCA2 genes, and for men with previously treated hormone-relapsed metastatic prostate cancer who have the same BRCA mutations.

NHS England today said the new treatments would benefit 550 men and 300 women a year.

Helen Knight, director of medicines evaluation at NICE, said: “We know how important it is for people with these types of cancer to have more treatment options that enable them to maintain or improve their quality of life.

“For people with this type of early breast cancer, being able to have a targeted treatment after surgery and chemotherapy will increase the chance of curing the disease and reduce the likelihood of developing incurable advanced disease.

“For people with advanced prostate cancer it can also mean delaying chemotherapy and its associated side effects and allowing them to have more time with their families and loved ones.”

Experts at The Institute of Cancer Research (ICR) thanked NHS England and AstraZeneca for reaching agreement following complex negotiations over how to price olaparib for different groups of cancer patients.

Professor Andrew Tutt, of the ICR and was part of the ICR team at the Breast Cancer Now Toby Robins Research Centre that carried our early laboratory work, said: “It is immensely satisfying to know this work will now allow patients within the NHS to join the many thousands of patients globally whose lives are transformed by this work.”

Professor Johann De Bono, professor in experimental cancer medicine at The ICT and consultant medical oncologist at The Royal Marsden NHS Foundation Trust, added: “Olaparib is a precision medicine which extends the lives of men with advanced prostate cancer who have mutations in their BRCA genes.

“For patients with advanced prostate cancer and mutations in BRCA1 or BRCA2, these recommendations will be life changing – giving men another treatment option and precious extra time with their families, without the debilitating side effects we see with chemotherapy.”

Professor Peter Johnson, National Clinical Director for Cancer, said: “This is an important development for hundreds with early breast cancer or advanced prostate cancer that has progressed after other types of treatment, offering both sets of patients a vital new option to treat their cancer.”

The treatment has been available on the NHS in England and Wales for women with advanced ovarian cancer, and inherited BRCA1 or BRCA2 mutations, who have stopped responding to treatment since January 2020. In Scotland, it has been available for these patients since July 2021 and has also been available for men with advanced, hormone-relapsed prostate cancer whose tumours have mutations in BRCA1 or BRCA2, since October 2021.

Olaparib is also licensed for use in patients with BRCA1 and BRCA2 mutations and advanced breast and pancreatic cancer, but it is not yet available on the NHS.

Today’s decision reverses NICE’s earlier provisional recommendation not to recommend olaparib for adults who have already had treatment with chemotherapy prior to or following surgery.

Evidence from a clinical trial showed that, at four years, more people having olaparib after chemotherapy and surgery were alive and free of any breast cancer compared with placebo (82.7% compared with 75.4%), and more people were alive overall (89.8% compared with 86.4%).

The announcement also updates NICE’s recommendation for treating prostate cancer that has BRCA1 or BRCA2 mutations and that has spread after previous therapies.

Given as a tablet, olaparib is a poly adenosine diphosphate-ribose polymerase (PARP) inhibitor, which prevents the DNA of cancer cells being repaired and stops them from growing and spreading while leaving healthy cells much less affected.

NICE expects to publish final guidance on olaparib for breast cancer and prostate cancer in May 2023.

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