The National Institute for Health and Care Excellence (NICE) have today announced they have approved the combination of olaparib (Lynparza) with bevacizumab (Avastin) for the maintenance treatment of high-grade epithelial ovarian cancer, fallopian tube cancer or primary peritoneal cancer in adults whose cancer:
- has completely or partially responded after first-line platinum-based chemotherapy in combination with bevacizumab
- is stages 3 or 4 and
- is homologous recombination deficiency (HRD) positive (defined by either a BRCA1/2 mutation and/or genomic instability)
Since April 2021, this ovarian cancer treatment combination has been available through the Cancer Drugs Fund. This means that it was previously assessed by NICE, and shown to be promising as an ovarian cancer treatment, but there wasn’t enough evidence available for a definite “yes” decision. The Cancer Drugs Fund gave access to this combination while more evidence was gathered.
At the most recent review, all evidence was looked at, including additional evidence gathered since 2021, and data on how cost-effective the treatment is. Based on this review, the ovarian cancer treatment combination has been recommended for routine use in the NHS.
“New, effective treatments are a crucial part of our vision for all women to survive ovarian cancer. Today's news shows why funding medical research to develop new treatments is vital. Now we need to ensure all patients are offered HRD testing at diagnosis so that they can benefit from this fantastic new treatment option."Marie-Claire Platt, Ovarian Cancer Action’s Head of Policy and Research
Florence Wilks, a member of the Ovarian Cancer Action Research Network, shared her ovarian cancer experience with the panel to help them understand the impact making this new ovarian cancer treatment available. Florence was diagnosed with advanced ovarian cancer in 2010 and told she had just 12-18 months to live. She spent two years going back and forth to her doctor with numerous symptoms before finally being diagnosed with stage 3c ovarian cancer. She’s since had four rounds of chemotherapy, two major surgeries, and has taken both Avastin and Olaparib.
Access to personalised treatments over the last decade has enabled her to see her children grow up, continue to do the things she loves and treat every day as a gift.
"Women with such a difficult diagnosis of advanced ovarian cancer need as many treatment options as possible to help combat the disease. This is such wonderful news."Florence Wilks, ovarian cancer patient
What does ‘maintenance treatment’ mean?
Maintenance treatments do not cure cancer, but they can prevent disease progression, meaning people have longer periods of time between further treatments where their cancer is stable. In this case, new evidence showed that people taking olaparib with bevacizumab have more time before their cancer comes back than people having bevacizumab alone, and that they also live longer.
What is HRD?
HRD stands for homologous recombination deficiency. This is what we call it when there is an error in one of the genes involved in repairing DNA. You may have heard of faulty BRCA1 or BRCA2 genes. They are just two of the genes involved in this DNA repair function, but there are many more.
Alterations in these genes can result in a higher risk of high-grade serous ovarian cancer, but also a better response to maintenance treatments known as PARP inhibitors. This treatment combination offers a new option for people who do not carry a BRCA mutation but are HRD positive.
HRD testing is performed on a sample of a tumour after surgery, at the same time and in a similar way to how tumour BRCA testing works currently.
If you have just been diagnosed with high-grade serous ovarian cancer, you should ask your oncologist about HRD testing as part of your treatment pathway.
If you have previously been tested and found to not carry a faulty BRCA gene, then you can be retested for HRD.
If you have a confirmed faulty BRCA gene (either through blood or tumour testing), you are classed as HRD positive so need no further testing to establish if you qualify for this treatment combination.
"This decision is very positive news. This will hopefully enable us to control ovarian cancer even more effectively for these women but will also allow us to test more women for the HRD markers which may help guide future treatment options as well."Dr Jonathan Krell, Consultant Medical Oncologist and Ovarian Cancer Action Researcher
NICE recommendations apply to England, but the recommendations are followed by NHS Wales (specifically the NHS in Wales must usually provide funding within 2 months of the guidance). There is a set process by which the Department of Health in Northern Ireland review NICE guideline and assess whether they are appropriate to implement. You can read more about this process here: https://online.hscni.net/our-work/nice/
Scottish Intercollegiate Guidelines Network (SIGN) make the recommendations for Scotland, where this maintenance treatment combination is currently available under NHS Scotland.