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(Nubeqa) for Non-Metastatic Castration Resistant Prostate Cancer

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(Nubeqa) for Non-Metastatic Castration Resistant Prostate Cancer pan-Canadian Oncology Drug Review Final Clinical Guidance Report Darolutamide (Nubeqa) for non-Metastatic Castration Resistant Prostate Cancer April 22, 2020 DISCLAIMER Not a Substitute for Professional Advice This report is primarily intended to help Canadian health systems leaders and policymakers make well-informed decisions and thereby improve the quality of health care services. While patients and others may use this report, they are made available for informational and educational purposes only. This report should not be used as a substitute for the application of clinical judgment in respect of the care of a particular patient or other professional judgment in any decision making process, or as a substitute for professional medical advice. Liability pCODR does not assume any legal liability or responsibility for the accuracy, completeness or usefulness of any information, drugs, therapies, treatments, products, processes, or services disclosed. The information is provided "as is" and you are urged to verify it for yourself and consult with medical experts before you rely on it. You shall not hold pCODR responsible for how you use any information provided in this report. Reports generated by pCODR are composed of interpretation, analysis, and opinion on the basis of information provided by pharmaceutical manufacturers, tumour groups, and other sources. pCODR is not responsible for the use of such interpretation, analysis, and opinion. Pursuant to the foundational documents of pCODR, any findings provided by pCODR are not binding on any organizations, including funding bodies. pCODR hereby disclaims any and all liability for the use of any reports generated by pCODR (for greater certainty, "use" includes but is not limited to a decision by a funding body or other organization to follow or ignore any interpretation, analysis, or opinion provided in a pCODR report). FUNDING The pan-Canadian Oncology Drug Review is funded collectively by the provinces and territories with the exception of Quebec, which does not participate in pCODR at this time. pCODR Final Clinical Guidance Report - Darolutamide (Nubeqa) for non-Metastatic Castration Resistant Prostate Cancer pERC Meeting: March 19, 2020; Early Conversion: April 22, 2020; Unredacted: October 2, 2020 © 2020 pCODR | PAN-CANADIAN ONCOLOGY DRUG REVIEW ii INQUIRIES Inquiries and correspondence about the pan-Canadian Oncology Drug Review (pCODR) should be directed to: pan-Canadian Oncology Drug Review 154 University Avenue, Suite 300 Toronto, ON M5H 3Y9 Telephone: 613-226-2553 Toll Free: 1-866-988-1444 Fax: 1-866-662-1778 Email: [email protected] Website: www.cadth.ca/pcodr pCODR Final Clinical Guidance Report - Darolutamide (Nubeqa) for non-Metastatic Castration Resistant Prostate Cancer pERC Meeting: March 19, 2020; Early Conversion: April 22, 2020; Unredacted: October 2, 2020 © 2020 pCODR | PAN-CANADIAN ONCOLOGY DRUG REVIEW iii TABLE OF CONTENTS DISCLAIMER ................................................................................................... ii FUNDING ....................................................................................................... ii INQUIRIES ...................................................................................................... iii TABLE OF CONTENTS ....................................................................................... iv LIST OF ABBREVIATIONS ................................................................................ 1 1 GUIDANCE IN BRIEF .................................................................................... 2 1.1 Introduction ........................................................................................ 2 1.2 Key Results and Interpretation ................................................................. 3 1.2.1 Systematic Review Evidence ........................................................ 3 1.2 2. Additional Evidence .................................................................. 8 1.2.3 Factors Related to Generalizability of the Evidence ......................... 10 1.2.4 Interpretation ......................................................................... 15 1.3 Conclusions ....................................................................................... 18 2 BACKGROUND CLINICAL INFORMATION ........................................................... 21 2.1 Description of the Condition .................................................................. 21 2.2 Accepted Clinical Practice ..................................................................... 21 2.3 Evidence-Based Considerations for a Funding Population .............................. 22 2.4 Other Patient Populations in Whom the Drug May Be Used ............................ 22 3 SUMMARY OF PATIENT ADVOCACY GROUP INPUT ............................................... 23 3.1 Condition and Current Therapy Information .............................................. 23 3.1.1 Experiences Patients have with Prostate Cancer ............................. 23 3.1.2 Patients’ Experiences with Current Therapy for Prostate Cancer ......... 25 3.2 Information about the Drug Being Reviewed .............................................. 28 3.2.1 Patient Expectations for and Experiences To Date with Darolutamide ... 28 3.3 Additional Information ......................................................................... 30 4 SUMMARY OF PROVINCIAL ADVISORY GROUP (PAG) INPUT ................................... 31 4.1 Currently Funded Treatments ................................................................ 31 4.2 Eligible Patient Population .................................................................... 31 4.3 Implementation Factors ........................................................................ 32 4.4 Sequencing and Priority of Treatments ..................................................... 32 4.5 Companion Diagnostic Testing ................................................................ 33 4.6 Additional Information ......................................................................... 33 5 SUMMARY OF REGISTERED CLINICIAN INPUT ..................................................... 34 5.1 Current Treatments for this nmCRPC .................................................... 34 5.2 Eligible Patient Population ................................................................. 35 5.3 Relevance to Clinical Practice ............................................................. 37 5.4 Sequencing and Priority of Treatments with Darolutamide ......................... 38 5.5 Companion Diagnostic Testing ............................................................. 39 5.6 Additional Information ...................................................................... 40 6 SYSTEMATIC REVIEW .................................................................................. 41 6.1 Objectives ......................................................................................... 41 6.2 Methods ............................................................................................ 41 6.2.1 Review Protocol and Study Selection Criteria ................................. 41 6.3 Results ............................................................................................. 43 6.3.1 Literature Search Results .......................................................... 43 6.3.2 Summary of Included Studies ...................................................... 44 pCODR Final Clinical Guidance Report - Darolutamide (Nubeqa) for non-Metastatic Castration Resistant Prostate Cancer pERC Meeting: March 19, 2020; Early Conversion: April 22, 2020; Unredacted: October 2, 2020 © 2020 pCODR | PAN-CANADIAN ONCOLOGY DRUG REVIEW iv 6.3.3 Detailed Trial Characteristics ..................................................... 44 6.4 Ongoing Trials .................................................................................... 72 7 SUPPLEMENTAL QUESTIONS ......................................................................... 73 7.1 Critical appraisal of an indirect treatment comparison ................................. 73 7.1.1 Background ............................................................................ 73 7.2.1 Objectives of ITC and NMAs ........................................................ 73 7.1.2 Methods ................................................................................ 73 7.1.4 Results .................................................................................. 74 7.1.5 Critical Appraisal of the Indirect Comparisons ................................. 82 7.1.6 Conclusion ............................................................................. 85 8 COMPARISON WITH OTHER LITERATURE .......................................................... 87 9 ABOUT THIS DOCUMENT ............................................................................. 88 APPENDIX A: LITERATURE SEARCH STRATEGY AND DETAILED METHODOLOGY ................ 89 REFERENCES ................................................................................................. 92 pCODR Final Clinical Guidance Report - Darolutamide (Nubeqa) for non-Metastatic Castration Resistant Prostate Cancer pERC Meeting: March 19, 2020; Early Conversion: April 22, 2020; Unredacted: October 2, 2020 © 2020 pCODR | PAN-CANADIAN ONCOLOGY DRUG REVIEW v LIST OF ABBREVIATIONS ADT Androgen deprivation therapy AE Adverse event AR Androgen receptor BICR Blinded independent central review BPI-SF Brief pain inventory – short form CGP Clinical Guidance
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