1.1
Abiraterone plus androgen deprivation therapy (ADT), with prednisolone or prednisone can be used, within its marketing authorisation, as an option to treat newly diagnosed high-risk hormone‑sensitive metastatic prostate cancer in adults.
1 Recommendations
What this means in practice
Abiraterone plus ADT, with prednisolone or prednisone must be funded in the NHS in England for the condition and population in the recommendation, if it is considered the most suitable treatment option. Abiraterone plus ADT, with prednisolone or prednisone must be funded in England within 30 days of final publication of this guidance.
There is enough evidence to show that abiraterone plus ADT, with prednisolone or prednisone provides benefits and value for money, so it can be used routinely across the NHS in this population.
Prednisone is not currently available in England, but it is included in the recommendation to match the abiraterone marketing authorisation.
NICE has produced tools and resources to support the implementation of this guidance.
Why this recommendation was made
This evaluation is a review of NICE technology appraisal guidance TA721.
Usual treatment for newly diagnosed high-risk hormone-sensitive metastatic prostate cancer is enzalutamide plus ADT or apalutamide plus ADT. Abiraterone plus ADT, with prednisolone or prednisone works in a similar way to these treatments, and would be offered to the same population.
Clinical trial evidence shows that abiraterone plus ADT, with prednisolone or prednisone is more effective than placebo plus ADT and ADT alone. Abiraterone plus ADT, with prednisolone or prednisone has not been directly compared in a clinical trial with enzalutamide plus ADT or apalutamide plus ADT, but indirect comparisons suggest that it is likely to work as well as these combinations.
A cost comparison suggests that the costs for abiraterone plus ADT, with prednisolone or prednisone are similar to or lower than both enzalutamide plus ADT and apalutamide plus ADT. To be recommended as a treatment option, abiraterone plus ADT, with prednisolone or prednisone has to cost less or have similar costs to 1 relevant comparator recommended in a published NICE technology appraisal guidance (see NICE's cost-comparison methods). So abiraterone can be used.
For all the evidence, see the committee papers. For more information on NICE's evaluation of enzalutamide plus ADT, see the committee discussion section in NICE's technology appraisal guidance on enzalutamide for treating hormone-sensitive metastatic prostate cancer. For more information on NICE's evaluation of apalutamide plus ADT, see the committee discussion section in NICE's technology appraisal guidance on apalutamide with ADT for treating hormone-sensitive metastatic prostate cancer.