NICE backs Astellas' Xtandi in pre-chemo patients, but J&J's Zytiga isn't so lucky

Astellas and Medivation's ($MDVN) prostate cancer med Xtandi has been coming up strong behind Zytiga from Johnson & Johnson ($JNJ) ever since hitting the market. And now, it's getting a boost in the U.K. that should help it gain more ground against its rival.

The country's cost watchdogs at the National Institute for Health and Care Excellence (NICE) have proposed endorsing Xtandi in the pre-chemo setting after concluding that the drug could improve survival and delay chemotherapy in a way that was cost-effective for the NHS.

But not so much with Zytiga. NICE agreed that the drug was well-tolerated and could also delay chemo, but it wasn't convinced that the "uncertain evidence" of a long-term benefit justified going outside its normal cost-effectiveness limits, it said.

The way NICE sees it, Zytiga's incremental cost-effectiveness ratio compared with best supportive care rings up between £35,500 and £59,600, while Xtandi's comes in at £34,500.

It's a key win for Xtandi, which snagged its European go-ahead to treat pre-chemo prostate cancer patients just over a year ago; its U.S. nod in the population came last September. Since then, it's been working to pare down the market share of Zytiga, which has been cruising since picking up its own pre-chemo nods in late 2012 in the U.S. and in early 2013 in Europe.

And J&J's Janssen unit isn't thrilled with the outcome. There's high demand for Zytiga in the U.K., Janssen's U.K. and Ireland managing director, Mark Hicken, told PharmaTimes--the med is currently the second most-requested med via the U.K.'s Cancer Drugs Fund, which provides it in the pre-chemo setting--and that makes NICE's decision "extremely disappointing."

"Our trial, one of the largest and longest in prostate cancer, clearly demonstrates long term survival and quality of life benefits for patients, which are also recognized by the clinical community," he said.

Of course, there's still an opportunity for J&J to come back with a discount. Drugmakers are often required to offer up so-called patient access schemes if they want to get their meds past the gatekeeper, and the body's chief exec, Sir Andrew Dillon, hinted that that was what it was after.

"It is obviously disappointing not to be able to recommend (Zytiga) at this point," he said in a statement.

But as some analysts figure, Zytiga may need to get used to watching Xtandi pass it by. Despite its head start, they expect to see the Astellas treatment come out on top, in part thanks to its more convenient dosing: Zytiga needs to be administered alongside prednisone, while patients take Xtandi on its own.

- read NICE's release
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