1.1 Olaparib is recommended as an option for the maintenance treatment of relapsed, platinum-sensitive, high-grade epithelial ovarian, fallopian tube, or primary peritoneal cancer in adults whose cancer has responded to platinum-based chemotherapy, only if:
they have a BRCA1 or BRCA2 mutation
they have had 2 or more courses of platinum-based chemotherapy
the company provides olaparib according to the commercial arrangement.
1.2 This recommendation is not intended to affect treatment with olaparib that was started in the NHS before this guidance was published. People having treatment outside this recommendation may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS clinician consider it appropriate to stop.
This appraisal is a partial review of NICE's technology appraisal guidance on olaparib for maintenance treatment of relapsed platinum-sensitive ovarian, fallopian tube or peritoneal cancer (TA620, now withdrawn). TA620 recommended olaparib for routine use in the NHS as an option for people who have had 3 or more courses of platinum-based chemotherapy. It also recommended it for use in the Cancer Drugs Fund as an option for people who have had 2 courses of platinum-based chemotherapy. This partial review specifically reviews the Cancer Drugs Fund recommendation for people who have had 2 courses of platinum-based chemotherapy. This updated guidance means that olaparib is now recommended for routine use in the NHS as an option for people who have had 2 or more courses of platinum-based chemotherapy. This guidance updates and replaces TA620. The committee discussion for TA620 is still available in the evidence section for this appraisal on the NICE website. This appraisal refers only to evidence covered by the partial review.
Why the committee made these recommendations
The original appraisal (TA620) concluded that olaparib extends the time until the cancer progresses compared with routine surveillance, regardless of whether the person has a BRCA mutation. But the company offered a commercial arrangement that applied to olaparib tablets when used for people with a BRCA mutation who have had 2 or more courses of platinum-based chemotherapy. This meant that olaparib is cost effective only when used for the subgroup of people with a BRCA mutation.
The new evidence includes data collected while olaparib was available in the Cancer Drugs Fund in England. The new clinical trial evidence confirms that people taking olaparib have more time before their cancer comes back than those having routine surveillance, and they also live longer.
The cost-effectiveness estimates are within what NICE considers an acceptable use of NHS resources. So, olaparib is recommended for routine use in the NHS.