NICE update: Lung cancer treatment gets green light

NICE guidance (TA520) recommends atezolizumab as an option for treating locally advanced or metastatic non-small-cell lung cancer (NSCLC) after chemotherapy.

It is recommended only if:

• Atezolizumab is stopped at two years of uninterrupted treatment or earlier if the disease progresses

• Roche provides atezolizumab discounted as agreed in the patient access scheme.

Locally advanced or metastatic NSCLC that has progressed after chemotherapy is often diagnosed late in life and has a poor prognosis. It is a debilitating condition with many distressing symptoms.

Platinum-based chemotherapy is given as a first treatment in people whose tumours are not epidermal growth factor receptor (EGFR)-positive, followed by docetaxel, or nintedanib plus docetaxel for people with adenocarcinoma. For those with EGFR-positive tumours, treatment starts with a tyrosine kinase inhibitor followed by platinum-based therapy.

For those with anaplastic lymphoma kinase (ALK)-positive tumours, standard treatment is ALK inhibitors followed by platinum-based chemotherapy. NICE technology appraisal guidance recommends pembrolizumab for treating PD-L1-positive NSCLC after chemotherapy; pembrolizumab is also recommended as an option for untreated PD-L1-positive NSCLC if the tumour expresses at least a 50% tumour proportion score. Nivolumab is also recommended by NICE for use within the Cancer Drugs Fund as an option if tumours are PD-L1 positive.

The annual incidence of adults with NSCLC in England is 33,300. It is estimated 4,000 people in England with NSCLC who are PD-L1-positive are eligible for treatment with atezolizumab each year; 1,800 who are PD-L1-positive will have atezolizumab from year 2019/20 onwards once uptake has reached 44%.

It is also estimated that 2,100 people in England with NSCLC who are PD-L1-negative are eligible for treatment with atezolizumab each year; 1,900 people will have atezolizumab from year 2019/20 onwards once uptake has reached 90%.

A resource impact template has been produced to support implementation of the guidance The comparators – pembrolizumab, nintedanib and nivolumab – also have patient access schemes. The use of atezolizumab is commissioned by NHS England. Providers are NHS hospital trusts.