More people could be offered genetic testing for genes linked to ovarian cancer in new draft NICE guideline for public consultation

NICE – September 2023

Anyone can carry a gene linked to ovarian cancer, including women, men, trans and non-binary people, and can pass it on to their children.

People may not know they are at higher risk, with best estimates suggesting only around 3% of people know they have a high-risk gene.

The guideline aims to raise greater awareness and increase the availability of genetic testing, allowing people to take preventive measures such as surgery, meaning fewer people will go on to develop ovarian cancer.   

People who could be carriers should be referred to genetics services for testing and offered counselling. This could include people who have had certain cancers, or if a blood relative has had breast or ovarian cancer.   

NICE recommends genetics services should assess the likelihood of people carrying the genes using a recognised mathematic model such as the Manchester scoring system, or criteria based on family history, and test for 1 of 9 identified pathogenic variants. These are: BRCA1, BRCA2, MLH1, MSH2, MSH6, RAD51C, RAD51D, BRIP1 and PALB2. 

Women, trans men and non-binary people registered female at birth who carry 1 of the genes should be offered information and support as part of discussions about the best option for reducing their risk of developing ovarian cancer. The most effective intervention is surgery to remove the ovaries. The draft guideline recommends this should happen no earlier than age 35, or 45 depending on the type of gene that is found.  

In some cases, a hysterectomy may also be considered to reduce the risk of endometrial as well as ovarian cancer. 

People from Ashkenazi and Sephardic Jewish family backgrounds have a higher risk of carrying the BRCA1 and BRCA2 genes, with around 280,000 people from these backgrounds expected to be eligible for testing. BRCA1 and BRCA2 genes are also linked to breast cancer.  

People from Greenlander family backgrounds also have a higher risk of having 1 of the pathogenic variants and it is expected that fewer than 1,000 will need testing. 

Further information – More people could be offered genetic testing for genes linked to ovarian cancer in new draft NICE guideline for public consultation

Over 700 people a year could benefit from a new potentially life-extending lung cancer drug which targets a specific genetic mutation

NICE | April 2022 | Over 700 people a year could benefit from a new potentially life-extending lung cancer drug which targets a specific genetic mutation

NICE has announced that a new treatment will be available for people with lung cancer. The innovative and potentially life-extending drug for treating people with a specific gene mutation of advanced non-small-cell lung cancer (NSCLC) has been recommended by NICE and will be available to patients from today (14 April 2022)

Full details are available from NICE

Further information about the project is available from NICE

NICE: Hundreds of people with some forms of urothelial cancer to receive new treatment

NICE | April 2022 | Hundreds of people with some forms of urothelial cancer to receive new treatment

Over 800 people with locally advanced or metastatic urothelial cancer are set to benefit from a new treatment – avelumab – following its recommendation for routine NHS funding in final draft guidance published last week (Thursday 7 April) by NICE.

Full details from NICE

Draft guidance Avelumab for maintenance treatment of locally advanced or metastatic urothelial cancer after platinum-based chemotherapy [ID3735] In development [GID-TA10624] Expected publication date: 11 May 2022

[NICE] Dostarlimab for previously treated advanced or recurrent endometrial cancer with high microsatellite instability or mismatch repair deficiency

NICE | March 2022 | Dostarlimab for previously treated advanced or recurrent endometrial cancer with high microsatellite instability or mismatch repair deficiency

Evidence-based recommendations on dostarlimab (Jemperli) for treating advanced or recurrent endometrial cancer with high microsatellite instability or mismatch repair deficiency in adults who have had platinum-based chemotherapy.

NICE Dostarlimab for previously treated advanced or recurrent endometrial cancer with high microsatellite instability or mismatch repair deficiency

NICE: Over 500 people a year can access a new life extending lung cancer treatment after NICE recommends its use within the Cancer Drugs Fund

 NICE | February 2022 | Over 500 people a year can access a new life extending lung cancer treatment after NICE recommends its use within the Cancer Drugs Fund

An innovative life-extending drug for treating mutation-positive locally advanced or metastatic non-small-cell lung cancer (NSCLC) in adults is being recommended by NICE as an option for use within the Cancer Drugs Fund.

Full details from  NICE

[NICE Draft Guideline] Transperineal biopsy for diagnosing prostate cancer

NICE | February 2022 | Transperineal biopsy for diagnosing prostate cancer

Four new diagnostic devices for men with suspected prostate cancer, which reduce the chances of biopsy related sepsis, have been recommended for use by NICE.

The new diagnostics guidance looks at local anaesthetic transperineal (LATP) prostate biopsy, using the freehand needle positioning devices PrecisionPoint, EZU-PA3U device, Trinity Perine Grid, and UA1232 puncture attachment, which are recommended as options for helping to diagnose prostate cancer.

Prostate cancer is the most diagnosed cancer in men in the UK according to Cancer Research UK. It mainly affects people over 50 and the risk is higher for people of African family background and people with a family history of prostate cancer.

At present NICE guidance recommends offering people with suspected clinically localised prostate cancer a multiparametric MRI as the first-line investigation.

If prostate cancer is still suspected based on the MRI image, a prostate biopsy is offered so that samples of the prostate can be collected for analysis. There are two ways of doing a prostate biopsy. In a transrectal ultrasound guided (TRUS) biopsy samples are collected using a biopsy needle inserted through the rectal wall via the anus.

However TRUS can be associated with serious infections, sometimes requiring hospital admission and antibiotic (Source: NICE). 

NICE Transperineal biopsy for diagnosing prostate cancer

Further information and documents available from NICE

ICR: NICE misses golden opportunity to enhance access to innovative cancer drugs

Institute of Cancer Research | n.d | NICE misses golden opportunity to enhance access to innovative cancer drugs

The Institute of Cancer Research (ICR) has responded to NICE’s proposals to reform its methods for assessing drugs for the NHS fell short of what was needed and in one important respect could make access to new cancer drugs worse. The ICR said too little had been done to favour drugs with innovative mechanisms of action, speed up approval of new drugs, or remove barriers to drug approval for rare diseases such as children’s cancer.

While the research institute is welcoming some of the changes NICE has proposed – especially its recommendation that review panels should accept more uncertainty in data when considering new medicines. But it wants to see further consideration and movement in several important areas:

• Greater recognition of the barriers for rare diseases.
• Risks of removing the end-of-life modifier
• Prioritising innovative medicines
• Using surrogate measures of survival (Source: ICR)

NICE misses golden opportunity to enhance access to innovative cancer drugs [news release]

See also:

MedScape NICE ‘Missed Golden Opportunity’ to Encourage Innovative Drugs

NICE: More than 100 people a year in England could benefit from new endometrial cancer treatment within the Cancer Drugs Fund

NICE | February 2022 | More than 100 people a year in England could benefit from new endometrial cancer treatment within the Cancer Drugs Fund

An innovative new drug for treating advanced or recurrent endometrial cancer in adults who have had platinum-based chemotherapy is being recommended by NICE as an option for use within the Cancer Drugs Fund.

NICE has published its final appraisal document on dostarlimab, an immunotherapy treatment which could benefit 124 people a year in England as a second-line treatment for endometrial cancer with high microsatellite instability or mismatch repair deficiency.

Endometrial cancer (EC) is a type of uterine cancer originating in the lining of the womb. Endometrioid carcinoma is the most common subtype, resulting in an estimated 2 162 deaths every year in the UK.

In normal cells, the body’s mismatch repair (MMR) system recognises and repairs genetic mismatches. However, 26 per cent of endometrial tumours have a defect in the MMR system, meaning unstable and dysfunctional DNA is not addressed.

There are currently a range of different treatment options available to people with advanced or recurrent endometrial cancer after having platinum-based chemotherapy. However, there are no standard second-line treatments, and the options provide limited survival benefit. Therefore, the prognosis for patients is poor.

Standard chemotherapy can take up to a day to be administered in hospital, but a dostarlimab infusion takes around 30 minutes (Source: NICE).

Full details are available from NICE

ICR responds to NICE decision not to recommend olaparib for advanced prostate cancer

Institute of Cancer Research | nd | ICR responds to NICE decision not to recommend olaparib for advanced prostate cancer

The Institute of Cancer Research, London, has expressed disappointment that NICE has decided not to recommend olaparib for previously treated, hormone-relapsed metastatic prostate cancer. 

It is the latest in a series of instances where it has not proved possible to widen availability of olaparib for additional cancer indications – highlighting the barriers that exist in taking even highly innovative treatments to patients.

Full response is available from the ICR

See also:

Medscape Experts Disappointed by NICE’s Decision to Reject Prostate Cancer Drug

National Health Executive NHS reject life-extending prostate drug due to NICE recommendations

[NICE updated guideline] Prostate cancer: diagnosis and management [NG131]

NICE | December 2021 | Prostate cancer: diagnosis and management [NG131]

This guideline covers the diagnosis and management of prostate cancer in secondary care, including information on the best way to diagnose and identify different stages of the disease, and how to manage adverse effects of treatment. It also includes recommendations on follow-up in primary care for people diagnosed with prostate cancer.

 A table of NHS England interim treatment regimens gives possible alternative treatment options for use during the COVID-19 pandemic to reduce infection risk. This may affect decisions for patients with prostate cancer. See the COVID-19 rapid guideline: delivery of systemic anticancer treatments for more details.

In December 2021, NICE reviewed the evidence and updated the recommendations on risk stratification to refer to a 5-tier model. Other recommendations were amended to reflect this change. For more information, see the update information.

Full details from NICE