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The National Institute for Health and Care Excellence (NICE) has recommended olaparib (Lynparza; AstraZeneca) for certain types of early breast cancer and metastatic prostate cancer, after the NHS reached a “landmark deal” on the cost of the drug.
Olaparib, a daily tablet, is from a class of targeted drugs called Poly (ADP-ribose) polymerase — or PARP — inhibitors. It targets cancers linked to faulty BRCA1 or BRCA2 genes and is already recommended for some types of ovarian cancer in England and for prostate cancer in Scotland.
In a decision announced on 6 April 2023, NICE said olaparib should be made available:
- As an option for the treatment of HER2-negative high-risk early breast cancer that has been treated with chemotherapy, in patients with BRCA1 or BRCA2 mutations;
- As an option for treating hormone-relapsed metastatic prostate cancer with BRCA1 or BRCA2 mutations that has progressed after a newer hormonal treatment.
In both cases, olaparib is only recommended if its manufacturer AstraZeneca provides it according to an agreed commercial arrangement.
According to NHS England, around 550 males with prostate cancer and 300 females with breast cancer could be eligible for this new drug each year in England, extending their lives by about six months, from 12 to 18 months.
In a statement published on 6 April 2023, Amanda Pritchard, chief executive of the NHS, said: “Reaching this landmark deal is not only incredible news for patients and their families but is another example of the NHS using its commercial capabilities that is good value for taxpayers and will help us to continue to transform cancer care across the country.”
The decision reverses a draft NICE recommendation against its use in breast cancer in November 2022 and in prostate cancer in October 2022 in technology appraisal TA831.
The price for olaparib is £2,317.50 per pack of 56 tablets, although this does not include the NHS discount agreed with AstraZeneca.
Chiara De Biase, director of support and influencing at Prostate Cancer UK, said: “This is the first targeted treatment of its kind to be approved for the disease and it finally moves us away from the old ‘one-size-fits-all’ approach to prostate cancer treatment.”
A statement from Baroness Delyth Morgan, chief executive at the charity Breast Cancer Now, said: “It’s fantastic news that olaparib, which is a ground-breaking and potentially life-saving treatment for certain people with primary breast cancer, has now been approved for use on the NHS.
“Today’s landmark deal follows an agonising wait since a devastating provisional rejection [in November 2022].”
Johann De Bono, professor in experimental cancer medicine at the Institute of Cancer Research in London, who led the trials of olaparib in the UK, commented: “Olaparib is an important example of how understanding the underlying genetics of patients, and their tumours’ genomics, can be used to design highly targeted precision medicines.”
