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Green light for cancer treatment for BRCA mutations

Approved for platinum-sensitive ovarian cancer

Jo Carlowe

Wednesday, 15 January 2020

The National Institute for Health and Care Excellence has recommended Olaparib as a treatment on the NHS for platinum-sensitive ovarian cancer

NICE has recommended olaparib tablets (Lynparza, AstraZeneca) for adults who have relapsed platinum-sensitive ovarian, fallopian tube or peritoneal cancer with a BRCA1 or BRCA2 mutation.

Evidence from clinical trials showed olaparib stalled growth of the cancer for around 13.6 months compared with placebo (19.1 months for olaparib, 5.5 months for placebo).

Olaparib is recommended for routine use in the NHS for people who have had three or more courses of platinum-based chemotherapy. It meets NICE’s end-of-life criteria and was found to be cost-effective for this group. It is estimated that around 100 people will be eligible for this treatment through routine commissioning.

For people who have had two courses of platinum-based chemotherapy, olaparib does not meet NICE’s end-of-life criteria. For this patient group, olaparib has the potential to be cost-effective if further data confirms the overall survival benefit. Olaparib is therefore recommended for use within the Cancer Drugs Fund (CDF) for people who have had two courses of platinum-based chemotherapy. It is estimated that around 1,100 people will be eligible for this treatment through the CDF.

Olaparib has previously been recommended in its capsule form for people with a BRCA mutation after three or more courses of platinum-based chemotherapy. According to the company, olaparib tablets will eventually replace the capsule form due to restrictions in its licencing status. Therefore, only olaparib tablets are covered by this appraisal.

In other announcements, NICE has not recommended gilteritinib for treating relapsed or refractory FLT3 mutation-positive acute myeloid leukaemia (AML) in adults. In published draft guidance, NICE stated: “Although the evidence suggests that gilteritinib can increase life expectancy by more than three months compared to current treatments, there is uncertainty around long-term survival. The most likely cost-effectiveness estimates for gilteritinib are also above the range that NICE would normally consider to be a cost-effective use of NHS resources.”

NICE has also currently refused pembrolizumab (also called Keytruda, made by Merck Sharp & Dohme) for untreated metastatic or unresectable recurrent head and neck squamous cell carcinoma (HNSCC), and has requested more clinical and cost-effectiveness evidence from Merck Sharp & Dohme.

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