NICE recommend rejecting degarelix for acute metastatic prostate cancer
Most unfortunately, NICE has recently recommended that degarelix should no longer be approved for use in patients presenting acutely with metastatic prostate cancer (a group within its current licensed indication). As a clinician I have often been faced with patients presenting as an emergency with painful bone metastases, ureteric obstruction, lymphoedema, systemic signs of cancer, very elevated PSA, spinal cord compression, liver failure and other complications of metastatic prostate cancer.
Currently, I only have one good clinical solution to these problems (the LHRH antagonist degarelix) and this is the option that we have always used in the past. If this decision by NICE becomes final, we are faced with having to use sub-optimal therapies (either postponing treatment until the anti-androgen and LHRH agonist kick in or bilateral orchidectomy) for these life-threatening instances. These are far from satisfactory and may actually be dangerous to our patients, and may lead to us being criticised as clinicians.
It is very disappointing that NICE is basing this decision on cost rather than clinical benefit, an outcome that leaves us doctors and our patients at considerable jeopardy.
What are your thoughts on this draft guidance? Can you think of examples where degarelix has proved to be the most effective option in acute metastatic prostate cancer? Please add your own views to this blog.
If you feel strongly about this, please follow this link to register your position on the ACD with NICE: