Prostate Scotland welcomes SMC acceptance of Enzalutamide for metastatic hormone-sensitive prostate cancer

Prostate Scotland welcomes SMC acceptance of Enzalutamide for metastatic hormone-sensitive prostate cancer to be available on NHS in Scotland 

Prostate Scotland, Scotland’s prostate disease charity, welcomed the decision of the Scottish Medicines Consortium earlier today to make Enzalutamide available on the NHS in Scotland for the treatment of metastatic hormone-sensitive prostate cancer.

‘This is a very welcome and positive decision and will potentially make a difference for men where their cancer has spread but is still sensitive to hormone treatment.

‘Men with hormone sensitive metastatic prostate cancer can face an uncertain future – as to whether their cancer will continue to respond to hormone treatment, or progress to becoming hormone resistant. Being able to maintain quality of life through keeping the period of hormone sensitivity as long as possible is very important. The availability of Enzalutamide for men with hormone-sensitive prostate cancer offers the potential for greater choice and opportunity of treatment, as well as the chance of progression free survival, or a potential delay in the progression of their cancer.  The decision of the SMC to approve Enzalutamide’s availability on the NHS in Scotland for metastatic hormone sensitive prostate cancer is a very helpful step forward and is very much welcomed’.

Research has shown that treatment with Enzalutamide for men with advanced prostate cancer which is still sensitive to hormone treatment (mHSPC) can lead to a delay in metastatic cancer progression and potentially lead to an improvement in overall survival by comparison to standard hormone therapy alone

We consulted men with prostate cancer in Scotland  who felt that the availability of Enzalutamide for men with metastatic hormone sensitive prostate cancer in Scotland would be helpful and that it should be made available on the NHS in Scotland.

Prostate cancer is an important issue in Scotland; it is the most common cancer in men in Scotland, with a lifetime risk of one in ten. We are pleased that there have been advances in treatment over the past few years, but there is still a need for further progress.

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Notes to Editors
For further information please contact Prostate Scotland at info@prostatescotland.org.uk or 0131 603 8660

In many cases where the prostate cancer has not spread, men will be offered surgery or radiotherapy treatments, with a curative intent. Men where the cancer has spread will usually be offered hormone treatment/Androgen Deprivation Treatment (ADT) to halt the growth of the cancer cells.  Where the prostate cancer is still sensitive to hormone treatment it is known as mHSPC. Often men will be offered abiraterone with prednisone (where they are at high risk of progression), or chemotherapy, in addition to ADT. Not all men will be suitable for chemotherapy or abiraterone and the availability of Enzalutamide in for men in this situation is very helpful.

The aim of treatment at this point is to continue to stop the cancer progressing to becoming hormone/castrate resistant. In some men after a period of time the cancer cells may adapt to or get used to lower levels of androgen, which fuels the cancer and start to grow again – this is known as castrate resistant prostate cancer.

An international trial called the ARCHES trial[i] ‘found Enzalutamide with ADT significantly reduced the risk of metastatic progression or death over time versus placebo plus ADT in men with mHSPC, including those with low-volume disease and/or prior docetaxel’. The reduction in risk of progression or death was 61%. It also showed a delay in pain progression. A separate trial -the ENZAMET trial[ii] showed that ’Enzalutamide was associated with significantly longer progression-free and overall survival than standard care in men with metastatic, hormone-sensitive prostate cancer receiving testosterone suppression’. It showed that overall survival at 3 years was 80% in the enzalutamide group and 72% in the standard-care group. Better results with enzalutamide were also seen in PSA progression-free survival and in clinical progression-free survival that men on and ADT alone.

Prostate cancer is the most common cancer amongst men in Scotland, with a lifetime chance of one in ten men developing it[[iii]]. There were over 37,009 new registrations of men with prostate cancer between 2008 and 2018 and 9,782 deaths of men in Scotland from prostate cancer during that period.[iv]. In 2018 in Scotland 4193 men were diagnosed with prostate cancer and 923 men in Scotland died from it[[v]]. Encouragingly survival rates amongst men with prostate cancer have doubled over the past two decades with 84% of men with prostate cancer now surviving it[[vi]]. Projections by the NHS show that the diagnosis of men with prostate cancer is likely to rise by up to 35% between now and 2027[[vii]].

Prostate Scotland is a registered Scottish charity no SC037494. It was set up in 2006 as a Scottish charity to develop awareness of prostate disease, to support men and their families/ partners with the disease through providing advice and information and to advance treatment and research into prostate disease. Its aim is to reach out across Scotland to create greater awareness amongst men and their families/partners about prostate disease and to advance treatment. It has established an award winning website www.prostatescotland.org.uk providing a wide range of information about prostate disease and treatments, as well as providing information and advice about prostate disease to men and their families across Scotland. In 2010 the charity won a national award for its impact on community health and in 2013 and 2015 was commended in the British Medical Association Patient information Awards, and in 2017 was awarded Scottish health charity of the year.

[i] Armstrong et al Journal or Clinical Oncology 2019 Nov 10; 37(32): 2974–2986  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6839905

[ii] Davis ID, Martin AJ, Stockler MR, et al. Enzalutamide with Standard First-Line Therapy in Metastatic Prostate Cancer. Clinical Trial N Engl J Med https://www.nejm.org/doi/10.1056/NEJMoa1903835

[iii] See Cancer Incidence in Scotland 2018 Public Health Scotland April 2020 pp21

[iv] See Cancer Incidence in Scotland 2018 Public Health Scotland April 2020, Cancer mortality in Scotland 2018 Public Health Scotland October 2019

[v] See Cancer in Scotland Public Health Scotland April 2020 and Scottish cancer registry Cancer mortality in Scotland 2018 Public Health Scotland October 2019 p8

[vi] Cancer in Scotland: ISD, NHS National Services Scotland, October 2018 pp 16-2

[vii]  See Scottish Cancer Registry May 2016 and Cancer Incidence in Scotland (2014), and Information Services Division NHS National Services Scotland November 2015