First targeted treatment approved for advanced prostate cancer on NHS in Scotland

The Scottish Medicines Consortium (SMC) has approved the use of the drug olaparib for some people in Scotland with a type of advanced prostate cancer. 

Olaparib (Lynparza) will be made available on the NHS in Scotland as a treatment for adults with prostate cancer that’s spread to other parts of the body and has stopped responding to treatments or surgery designed to reduce testosterone production (castration resistant).  

It will be an option for people with faults in the BRCA1 or BRCA2 genes – changes in particular genes that increase the chance of developing cancer – and where people’s cancers have progressed after being treated with a hormone therapy, such as abiraterone or enzalutamide.  

For those advanced prostate cancer patients who can now get olaparib, today’s decision will offer them a treatment option which can give them time to make more memories with their loved ones.

David Ferguson, public affairs manager for Cancer Research UK in Scotland. 

A targeted treatment 

1 in 400 people in the UK have the BRCA1 or BRCA2 gene mutations, both of which are associated with an increased risk of developing prostate cancer. Patients with BCRA-positive diseases also tend to be of a younger age and experience more aggressive forms of cancer. 

Olaparib is a type of targeted cancer treatment that blocks an enzyme called PARP from working, known as a PARP inhibitor. Without PARP, it’s more difficult for cancer cells to repair, making them more likely to die. 

“Cancer Research UK played a leading role in the first clinical trials for olaparib, which led to it being used routinely to treat ovarian cancer in patients who have the BRCA1 and BRCA2 gene faults and it’s really encouraging that olaparib can now be used for more types of cancer,” said David Ferguson, Cancer Research UK’s public affairs manager in Scotland.  

Clinical trial results find olaparib to be superior  

In a late-stage clinical trial, patients taking olaparib lived without their cancer getting any bigger for an average of 7.4 months, in comparison to 3.6 months for those taking existing treatments, in this case either abiraterone or enzalutamide. 

In the clinical trial, olaparib was compared with the investigators choice of hormone therapy. However, clinical expert advice is that chemotherapy is likely to be the most relevant comparator in NHS Scotland.  

Although there was no direct comparison of olaparib to chemotherapy, an indirect treatment comparison was made for olaparib versus the chemotherapy drug cabazitaxel. The results favoured olaparib over cabazitaxel for length of time before the cancer progressed, although the difference in overall survival was uncertain. 

The SMC also considered patient and clinician views, including the hope that olaparib would improve people with advanced prostate cancer’s quality of life by giving people more time before their cancer grows.

The group also said that an oral treatment would allow patients to receive treatment at home rather than the hospital visits currently required for chemotherapy. Olaparib also has more tolerable side effects than chemotherapy.   

“It’s great news that olaparib has been approved to treat metastatic prostate cancer for people in Scotland who carry BRCA1 and BRCA2 gene mutations,” said Ferguson. “Olaparib is a really important tool for treating patients with these mutations who have cancer which has come back after chemotherapy.” 

England, Wales and Northern Ireland have a separate process for reviewing drugs.