The NHS in England is to offer thousands of cancer patients the world’s first cancer drug to target an inherited genetic fault, after a U-turn by the health watchdog.
The National Institute for Health and Care Excellence (Nice) opted last year not to recommend olaparib for breast cancer patients with the so-called “Angelina Jolie gene” because of its high cost. The pioneering drug’s list price is £2,317.50 for one pack of 150mg tablets, excluding VAT.
But after NHS England struck a deal with AstraZeneca to provide the drug at an undisclosed discount, Nice has reversed its decision.
It has given olaparib the green light for use in women with HER2-negative, high-risk early breast cancer who have inherited faults in their BRCA1 or BRCA2 genes. Olaparib reduces the risk of breast cancer returning within four years by nearly a third.
Nice said the drug could also be offered to men with previously treated hormone-relapsed advanced prostate cancer with the same BRCA mutations. Olaparib may extend their lives by an average of six months, NHS England said.
The drug is already available on the NHS for women with advanced ovarian cancer and inherited BRCA1 or BRCA2 mutations who have stopped responding to treatment.
About 1,000 patients every year will now be eligible for the drug in England.
The chief executive of NHS England, Amanda Pritchard, said olaparib would have a “huge impact” on patients, “giving many a better chance of survival while offering those with advanced forms of the disease precious extra months to live”.
Given as a tablet, olaparib is a revolutionary type of targeted anti-cancer medicine called a poly adenosine diphosphate-ribose polymerase (PARP) inhibitor.
PARP is an enzyme that helps cells repair damaged DNA. By blocking this enzyme in patients, PARP inhibitors prevent the DNA of cancer cells being repaired, preventing them from growing and spreading while leaving healthy cells much less affected.
The Institute of Cancer Research, London (ICR), which played a crucial role in the drug’s development, hailed the NHS England/AstraZeneca deal and the U-turn by Nice as “amazing”.
“This is a momentous development in the treatment of cancers linked to faulty BRCA1 and BRCA2 genes,” said Prof Kristian Helin, the ICR chief executive.
“I am delighted that access to olaparib on the NHS, the first cancer drug in the world to target an inherited genetic fault, is being expanded to more patients who are in desperate need of better options.”
ICR scientists were the first to demonstrate that cancer cells with mutations in BRCA1 or BRCA2 were highly susceptible to PARP inhibitors like olaparib.
Clinical trials of olaparib, led by researchers from the ICR and the Royal Marsden NHS foundation trust, then showed that olaparib was effective for patients with a range of cancers associated with BRCA1 or BRCA2 mutations.
Delyth Morgan, the chief executive of the charity Breast Cancer Now, said about 5%-10% of women with breast cancer carried an inherited altered gene, of which the BRCA1 and 2 genes are the most common.
“Crucially, olaparib can reduce the risk of people’s cancer returning or progressing to incurable secondary breast cancer and stop people dying from this devastating disease,” she said.
Chiara De Biase, the director of support and influencing at Prostate Cancer UK, described the news as a landmark moment that “finally moves us away from the old ‘one size fits all’ approach to prostate cancer treatment”.
The actor Angelina Jolie had a preventive double mastectomy in 2013 to reduce her risk of developing cancer after being found to have a BCRA mutation.
