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Background

Degarelix (Firmagon, Ferring Pharmaceuticals) is a selective gonadotrophin-releasing hormone (GnRH)/luteinising hormone-releasing hormone (LHRH) antagonist which holds a European marketing authorisation for the treatment of adult male patients with advanced hormone-dependent prostate cancer.

Compared with its main comparators, the LHRH agonists, degarelix has the benefit of avoiding an initial ‘testosterone flare’ at the start of treatment. Testosterone flare is thought to increase the risk of spinal cord compression (SCC).

Degarelix was appraised by NICE under the Single Technology Appraisal (STA) process in 2014. Uncertainty remains regarding the cost-effectiveness of degarelix relative to LHRH agonists in subgroups of patients with different risks of SCC and whether the patients who would benefit most from treatment with degarelix can be reliably identified in clinical practice.

Objectives

1. To identify any relevant information on the rate of spinal cord compression (SCC) in people with metastatic hormone-dependent prostate cancer, or if possible, those with spinal metastases.

2. To explore the possibility of undertaking a subgroup analysis in people with spinal metastases and to perform an economic analysis if sufficient data are available to do so.

NICE appraisal

DSU report

Degarelix for treating advanced hormone-dependent prostate cancer [ID590]: Spinal cord compression associated with hormonal therapy in men with hormone-dependent metastatic prostate cancer: A systematic review and economic assessment (PDF, 194KB)