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Talazoparib with enzalutamide for untreated hormone-relapsed metastatic prostate cancer

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1 Recommendations

1.1

Talazoparib with enzalutamide should not be used for untreated hormone-relapsed metastatic prostate cancer in adults when chemotherapy is not clinically indicated.

1.2

This recommendation is not intended to affect treatment with talazoparib with enzalutamide that was started in the NHS before this guidance was published. People having treatment outside this recommendation may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS healthcare professional consider it appropriate to stop.

What this means in practice

Talazoparib with enzalutamide is not required to be funded and should not be used routinely in the NHS in England for the condition and population in the recommendations.

This is because the available evidence does not suggest that talazoparib with enzalutamide is value for money in this population.

Why the committee made these recommendations

Usual treatment for untreated hormone-relapsed metastatic prostate cancer is abiraterone plus prednisolone, enzalutamide alone, or olaparib plus abiraterone and prednisolone.

Clinical trial evidence shows that talazoparib plus enzalutamide increases how long people have before their condition gets worse and how long people live compared with enzalutamide plus placebo.

Talazoparib plus enzalutamide has only been compared indirectly with abiraterone plus prednisolone, and olaparib plus abiraterone and prednisolone. The results are uncertain, so it is unclear how well it works compared with these treatments.

There are also uncertainties in the economic model because it does not include all the usual treatments.

Because of the uncertainties in the economic model and the indirect comparisons it is not possible to determine the most likely cost-effectiveness estimates for talazoparib plus enzalutamide. So, it should not be used.