Niraparib can be used as an option for the maintenance treatment of advanced epithelial (FIGO stages 3 and 4) high-grade ovarian, fallopian tube or primary peritoneal cancer after a response to first-line platinum-based chemotherapy in adults, only if:
they did not have or could not tolerate bevacizumab as part of first-line induction chemotherapy
the company provides niraparib according to the commercial arrangement.
This recommendation is not intended to affect maintenance treatment with niraparib for advanced (FIGO stages 3 and 4) high-grade epithelial ovarian, fallopian tube or primary peritoneal cancer after response to first-line platinum-based chemotherapy that was started in the Cancer Drugs Fund before this guidance was published and that is not covered by recommendation 1.1. For those people, niraparib will be funded by the company until they and their NHS healthcare professional consider it appropriate to stop.
Niraparib must be funded in the NHS in England for the condition and population in the recommendations, if it is considered the most suitable treatment option. Niraparib must be funded in England within 90 days of final publication of this guidance.
There is enough evidence to show that niraparib provides benefits and value for money, so it can be used routinely across the NHS in this population.
NICE has produced tools and resources to support the implementation of this guidance.
This evaluation reviews the evidence for niraparib for the maintenance treatment of advanced (FIGO stages 3 and 4) high-grade epithelial ovarian, fallopian tube or primary peritoneal cancer (from here, advanced ovarian cancer) after response to first-line platinum-based chemotherapy in adults (NICE technology appraisal guidance 673). It also reviews new evidence collected during the managed access period, which includes evidence from clinical trials and from people having treatment in the NHS in England.
For this evaluation, niraparib was considered only for people who did not have or could not tolerate bevacizumab as part of first-line induction chemotherapy, in line with the evidence provided by the company. This does not include everyone who it is licensed for.
For people who would not have bevacizumab, usual treatment for advanced ovarian cancer is olaparib or rucaparib.
Clinical trial evidence shows that niraparib increases how long people have before their condition gets worse compared with placebo. Niraparib has not been directly compared in a clinical trial with olaparib or rucaparib. Results from indirect comparisons are highly uncertain but suggest that niraparib may work as well as olaparib and rucaparib.
The cost-effectiveness evidence, based on an assumption that niraparib works as well as olaparib and rucaparib, suggests that costs for niraparib are similar to or lower than costs for olaparib and rucaparib. The most likely cost-effectiveness estimates show that niraparib is a cost-effective option. So, it can be used.