A potentially life-extending drug combination for some people with advanced, high-grade epithelial ovarian, fallopian tube or primary peritoneal cancer will now be available on the Cancer Drugs Fund (CDF), following its approval by NICE in draft guidance.
The draft guidance recommends AstraZeneca’s Lynparza (olaparib) used with Roche’s Avastin (bevacizumab) as an option for people whose cancer has had a complete or partial response after first-line treatment with platinum-based chemotherapy and bevacizumab. The cancer must also test positive for homologous recombination deficiency (HRD).
Taken twice-daily in pill form, olaparib is a type of drug called a poly-ADP-ribose polymerase (PARP) inhibitor. These work by blocking PARP proteins which repair DNA in damaged cancer cells, causing the cells to die.
Currently, the ovarian cancer treatment pathway in England means that people without a mutation in the BRCA genes have to wait until the cancer has come back, when the prognosis is worse, to gain access to a PARP inhibitor. This new recommendation means that patients with HRD would be eligible for the treatment, regardless of BRCA status. Around 1,100 women will now be eligible for this treatment in England.
Clinical trial evidence suggests that olaparib plus bevacizumab increases the length of time people live before the disease progresses, compared with a placebo plus bevacizumab (37.2 months versus 17.7 months, respectively). However, clinical trial data is unclear on whether the combination treatment increases overall survival.
Due to the lack of data on the overall-survival benefit, the cost effectiveness estimates are uncertain so the treatment cannot be recommended for routine use in the NHS.
The committee recognised that olaparib with bevacizumab has the potential to be cost-effective if found to increase survival, and therefore recommended it for use on the CDF. This will allow more evidence to be collected to address the uncertainties around overall survival.
Meindert Boysen, director of the NICE Centre for Health Technology Evaluation, said: “We recognise how important it is to have treatments that postpone disease progression, as they allow people a better quality of life.
“Olaparib with bevacizumab has shown the potential to improve the lives of hundreds of individuals. We don’t yet know whether the benefits on disease progression translate in longer-term outcomes, and we look forward to seeing what the time spent on the CDF will uncover about its benefits for the future.”