Drugs we are denied

I read a post here recently from a lady with information about a new drug called 'niraparib', which has undergone trials in Denmark. The trial results have shown that this drug could be of possible help to women with recurring PPC & OC - like me. I forwarded this information to my CNS who in turn passed it to my Oncologist but the reply came back that yes they are aware of it but it is not licenced and unavailable here. I feel we are missing out on so many possibilities to extend our lives.

Lynne x

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  • Hi lynne

    It sounds a promising drug, waiting for licence in America and Europe

    just hope we all get chance to use it !

    Best wishes judy x

  • Hi

    I think one of the trials was here in UK. I also feel that we could have more access to drugs like Avastin- which is currently funded only for first line treatment . The NHS has so many things to pay for but the drug companies could do more to bring prices down.

    I wonder if we patients could do more to put pressure on? Lx

  • Here in Ireland our Health Service isnt the best and some of the newer drugs are not made available. We can only be proactive in fighting for better treatments and more awareness.

  • I read about this today. I wonder how long it will take to license.

    Debs xx

  • Here is a c&p of the article I read. You have to register to get full access.

    'Published in Oncology

    News · October 10, 2016

    Niraparib Significantly Improves Outcome of Ovarian Cancer Patients in Landmark Trial

    ESMO Press Commentary

    Save Recommend Share

    LUGANO-COPENHAGEN, 8 October 2016 – The PARP inhibitor niraparib significantly improves the outcome of platinum-sensitive recurrent ovarian cancer, according to full data from the ENGOT-OV16/NOVA trial presented for the first time at the ESMO 2016 Congress in Copenhagen and published in the New England Journal of Medicine (NEJM). The trial met its primary endpoint, with niraparib considerably prolonging progression-free survival compared to placebo.

    “There are limited treatment options in recurrent ovarian cancer,” said lead author Dr Mansoor Raza Mirza, chief oncologist, Rigshospitalet, Copenhagen University Hospital, Denmark and medical director of the Nordic Society of Gynaecological Oncology (NSGO). “Cumulative toxicity with platinum-based chemotherapy and lack of additional benefit limits its use. We then pause treatment until the next relapse and start combination chemotherapy.”

    “The current options for maintenance therapy in the EU are bevacizumab, which can only be given once and improves progression-free survival by just a few months, and the PARP inhibitor olaparib, which is only approved in patients with a germline BRCA mutation (about 10–15% of ovarian cancer patients). No maintenance therapy is approved outside the EU,” he continued.

    This phase III trial was performed in collaboration with European Network of Gynaecological Oncology Trial groups (ENGOT). The ENGOT-OV16/NOVA trial evaluated the efficacy and safety of the PARP inhibitor niraparib as maintenance therapy in patients with recurrent ovarian cancer who respond to platinum-based chemotherapy. Patients were assigned to cohorts by BRCA mutation status and randomised 2:1 to receive niraparib 300 mg or placebo once daily.

    The trial included 553 patients, of whom 203 had the germline BRCA mutation and 350 did not. Niraparib significantly improved the primary endpoint of progression-free survival compared to placebo in both cohorts, as well as in all subgroups.

    Median progression-free survival with niraparib compared to placebo was 21.0 vs 5.5 months in the germline BRCA mutation group (hazard ratio [HR] 0.27, 95% confidence interval [CI] 0.173 to 0.410, p<0.0001), 9.3 months vs 3.9 months in the non-germline BRCA mutation group (HR 0.45, 95% CI 0.338 to 0.607, p<0.0001), and 12.9 vs 3.8 months in a subgroup of the non-mutation cohort who had homologous recombination DNA repair deficiencies (HRD) (HR 0.38, 95% CI 0.243 to 0.586, p<0.0001).

    More than 10% of patients had grade 3/4 adverse events following treatment with niraparib, of whom 28% had thrombocytopaenia, 25% had anaemia, and 11% had neutropaenia. These were resolved with dose adjustments and patients could continue their treatment. Patient-reported outcomes were similar with niraparib and placebo. Patients on niraparib maintained symptom control and had a quality of life comparable to those on placebo.

    Significant improvements were also observed in all secondary endpoints. Compared to placebo, niraparib significantly prolonged the second progression-free survival, time to first subsequent treatment, and chemotherapy-free interval in the mutation and mutation-free groups, and in the HRD subgroup.

    “This is a breakthrough for patients with ovarian cancer,” said Mirza. “We have never seen such large benefits in progression-free survival in recurrent ovarian cancer. Niraparib significantly improved all endpoints across a broad patient population representing 70% of all ovarian cancer patients. These landmark results could change the way we treat this disease.”

    He concluded: “Once it is approved by the regulatory authorities, I’ll consider niraparib for all my patients with recurrent ovarian cancer who respond to platinum regardless of BRCA status.”

    Commenting on the results, Dr Andrés Poveda, head of the Gynaecological Cancer Clinic, Oncology Foundation Institute Valencia, Spain, said: “This study more than doubles the population of patients who benefit from a PARP inhibitor.”

    “Personalised medicine has arrived in high grade serous ovarian cancer,” he continued. “This was the first trial to use HRD to select patients for treatment and showed that it is a useful strategy. We also know that PARP inhibitors benefit patients with BRCA mutations.”

    Poveda concluded: “Future studies are needed to unravel which patients with HRD are not responders to PARP inhibitors and why, and which patients are long responders and why. We also need to know if there are other non-HRD factors, such as cyclin E positivity, that predict which patients will respond to treatment.

    Abstract for LBA3_PR

    A randomized, double-blind phase 3 trial of maintenance therapy with niraparib vs placebo in patients with platinum-sensitive recurrent ovarian cancer (ENGOT-OV16/NOVA trial)

    M.R. Mirza1, B.J. Monk2, A. Oza3, S. Mahner4, A. Redondo5, M. Fabbro6, J. Ledermann7, D. Lorusso8, I.B. Vergote9, O. Rosengarten10, J. Berek11, J. Herrstedt12, A.V. Tinker13, A. Dubois14, A. Gonzalez Martin15, P. Follana16, B. Benigno17, B.J. Rimel18, S. Agarwal19, U. Matulonis20

    1Department of Oncology 5073, NSGO & Rigshospitalet-Copenhagen University Hospital, Copenhagen, Denmark, 2Department of Oncology, University of Arizona Cancer Center-Phoenix, Phoenix, AZ, USA, 3Department of Oncology, University Health Network, Toronto, ON, Canada, 4Department of Gynegology, AGO & University of Munich, Hamburg, Germany, 5Department of Oncology, GEICO & Hospital Universitario, Madrid, Spain, 6Department of Oncology, GINECO & Institut du Cancer de Montpellier, Montpellier, France, 7Department of Medical Oncology, NCRI & University College London, London, UK, 8Department of Gynecologic Oncology, MITO/MaNGO & Fondazione IRCCS National Cancer Institute, Milan, Italy, 9Department of Obstetrics and Gynecology, BGOG & University of Leuven, Leuven, Belgium, 10Department of Gynecologic Oncology, ISGO & Sha’are Zedek Medical Center, Jerusalem, Israel, 11Department of Oncology, Stanford Women’s Cancer Center, Stanford, CA, USA, 12Department of Oncology, NSGO & Odense University Hospital, Odense, Denmark, 13Department of Medicine, British Columbia Cancer Agency, Vancouver, BC, Canada, 14Department of Oncology, AGO & Kliniken Essen Mitte, Essen, Germany, 15Medical Oncology Department, GEICO & MD Anderson Cancer Center Madrid, Madrid, Spain, 16Department of Medical Oncology, GINECO & Centre Antoine Lacassagne, Nice, France, 17Department of Gynecologic Oncology, University Gynecologic Oncology, Atlanta, GA, USA, 18Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, West Hollywood, CA, USA, 19Department of Medical Affairs, Tesaro, Inc, Waltham, MA, USA, 20Department of Gynecologic Oncology, Dana-Farber Cancer Institute, Boston, MA, USA

    Background: Niraparib is an oral, highly selective inhibitor of PARP1/2. This is the first randomized phase 3 trial of a PARP inhibitor as maintenance therapy post-platinum chemotherapy in patients (pts) with platinum-sensitive recurrent ovarian cancer.

    Methods: Two independent cohorts were enrolled based on results of BRACAnalysis® testing: pts with a germline BRCA mutation (gBRCAmut), and pts who lacked these mutations (non-gBRCAmut). Within each cohort, pts were randomized (2:1) to receive niraparib 300 mg or placebo once daily. Three prospectively-defined populations were assessed: 1) the gBRCAmut cohort; 2) those in the non-gBRCAmut cohort whose tumors were retrospectively defined as deficient in homologous recombination (HRD) by the myChoice® HRD test; 3) the overall non-gBRCAmut cohort.

    Results: 553 pts were enrolled in this international trial. 60% of pts had 2 lines of prior therapy, and 40% of pts had >2 prior lines. 76% of pts had stage IIIc or IV disease. Niraparib prolonged progression-free survival (PFS) as compared to placebo in all three pt populations (Table 1). Secondary endpoints of chemotherapy-free interval (CFI), time to first subsequent treatment (TFST), and PFS 2 also showed statistically significant improvement. Patient-reported outcomes (PRO) were similar for niraparib and placebo. Most common (≥10%) treatment-emergent grade 3/4 adverse events in niraparib-treated pts were thrombocytopenia (28%), anaemia (25%), and neutropenia (11%). There were no deaths during study treatment.

    Table. Progression-free Survival

    gBRCAmut n=203

    non-gBRCAmut n=350

    non-gBRCAmut HRDpos n=162

    Niraparib n=138

    Placebo n=65

    Niraparib n=234

    Placebo n=116

    Niraparib n=106

    Placebo n=56

    PFS Median, Months (95% CI)

    21.0 (12.9, NR)

    5.5 (3.8, 7.2)

    9.3 (7.2, 11.2)

    3.9 (3.7, 5.5)

    12.9 (8.1, 15.9)

    3.8 (3.5, 5.7)

    p value

    <0.0001

    <0.0001

    <0.0001

    Hazard Ratio Niraparib:Placebo (95% CI)

    0.27 (0.173, 0.410)

    0.45 (0.338, 0.607)

    0.38 (0.243, 0.586)

    *NR=Not reached

    Conclusions: Niraparib significantly improved PFS for all study populations as well as significantly prolonging CFI, TFST and PFS 2 with a manageable safety profile and without adversely impacting PRO.

    Copyright © 2016 Elsevier Inc. All rights reserved.'

  • Many thanks for posting the article! Sounds very promising ! Let's hope it gets to those who need it asap! Xx

  • Hi, I agree we are missing out on a lot. I read the American site Inspire. Ladies there are on lots of things that we are still testing. Some ladies are on Avastin for years and doing well. I have never had it and now my situation is serious they won't let me buy it. Some of the Parps are also working on non BRCA ladies, but they don't do that here either.

    Frustrated to see more drugs available elsewhere.

  • I live in the Channel Islands so even Avastin not funded & my insurance company only covered 5 during chemo.

    For myself, I started the drug regimen & diet advice from COC in London after surgery & before chemo. Still on it.

    Stage 3C but now NED for 10 months with ca125 at 8. What do I have to lose sticking with that at mo? Looks like it cd b working so I'm incredibly grateful to them. See how I do

  • Hi Sherrym and all who replied.

    I also tried COC in London as I know Trixie did too. My beast is back for third time after diagnosis for PPC stage IV diagnosed in January 2014, which was followed by usual chemo, debulking and more chemo. My onc did not want me to continue COC regime whilst on chemo, as she said she had seen some patients who had presented with liver complications whilst taking the statins. I am now back on carbo + gem until February. I feel I could soon be running out of options.

    I am sitting here thinking that there must be some course of action that we Ladies could consider collectively to bring our plight of these 'non allowed' drugs to the government's attention - maybe some kind of petition.

    A local lady doctor here in Henley-On-Thames, where I live, recently managed to overturn a decision by the 'powers that be' to deny her a life-saving chemo drug. She set up a petition which was acknowledged by hundreds of people and with publicity in the local newspaper 'The Henley Standard', the decision was reversed.

    Does anyone have any bright ideas? I feel our voices could be heard if we could pull together nationwide.

    What do you think?

    Lynne x

  • I must admit to being cross for being denied Avastin. Does anyone know when the NICE guidelines changed to it being offered to patients with over 1cm of disease remaining after surgery? I was left with less than 1cm then after two more chemos declared 'clear'.. I'm grateful for that of course, but feel a belt and braces approach would have been sensible. Xx

  • The trial in the UK is not complete yet. There has been a question over PARP inhibitors only being available for those who are genetic positive. The trial is to see if it helps other too. This is for people who have had at least two recurrences with a good response. It was suggested to me when I recurred, however the side effects are pretty yuk.

    When the drug companies were put under pressure by the select committee they dropped the price of some drugs, so maybe it's time to get on the MP's case to push for more of this.

    LA

  • I have read varying reports some saying it may help those that are not BRCA. mut. as well as those that are and the side effects no worse than some other drugs. Considering that I am not BRCA mut., have recurred now for third time and already experienced some very unpleasant side effects, I would be willing to give it a go.

    Lynne

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