2 The technology
2.1 Enzalutamide (Xtandi, Astellas) is an androgen receptor antagonist that acts on the androgen receptor signalling pathway to decrease the proliferation of cancer cells and induce cancer cell death. It is administered orally. Enzalutamide is indicated for the treatment of 'adult men with metastatic castration‑resistant prostate cancer who are asymptomatic or mildly symptomatic after failure of androgen deprivation therapy in whom chemotherapy is not yet clinically indicated'.
2.2 The most common adverse reactions with enzalutamide are tiredness, headache, hot flushes and high blood pressure. For full details of adverse reactions and contraindications, see the summary of product characteristics.
2.3 The cost (list price) of enzalutamide is £2734.67 for a 112‑capsule pack of 40 mg enzalutamide. The daily dose of enzalutamide is 160 mg and costs £97.67 per day. The company has agreed a patient access scheme with the Department of Health. This is a simple discount to the list price of enzalutamide. The level of the discount is commercial in confidence, and has been changed from that used in NICE's technology appraisal on enzalutamide for metastatic hormone-relapsed prostate cancer previously treated with a docetaxel-containing regimen. The same level of discount is applicable to both the indication for enzalutamide in this appraisal and that of the technology appraisal on enzalutamide for metastatic hormone-relapsed prostate cancer previously treated with a docetaxel-containing regimen. The Department of Health considered that this patient access scheme would not constitute an excessive administrative burden on the NHS.