Immunotherapy drug pembrolizumab (also known as Keytruda) used with chemotherapy drugs carboplatin and paclitaxel will now be an option for adults with squamous non-small-cell lung cancer (NSCLC) which has spread to other parts of the body and who haven’t had any previous treatments.
Around 7,500 people in England are diagnosed each year with this type of lung cancer, of whom approximately 1,700 may be eligible for pembrolizumab combination therapy.
Made by Merck, Sharpe & Dohme, pembrolizumab works by targeting a specific protein on the surface of cells which is involved in the body’s immune response to cancer.
Evidence from an ongoing clinical trial suggests that people who have pembrolizumab combination therapy could live longer than those who have standard chemotherapy. It also suggests people could have additional time without their cancer progressing compared with standard chemotherapy.
However, because the clinical evidence is immature, the cost-effectiveness estimates for pembrolizumab combination therapy are very uncertain. There is also uncertainty about whether the combination therapy would meet the criteria for being considered a life-extending treatment at the end of life when compared with standard chemotherapy; however, the committee concluded that this criteria may be met.
The committee recognised that pembrolizumab combination therapy has the potential to be cost-effective, and therefore recommended it for use on the CDF. This will allow more evidence to be collected to address the uncertainties around overall survival.
The draft guidance recommends that treatment with pembrolizumab combination therapy is stopped after a maximum of 2 years. This is in line with the available clinical- and cost-effectiveness evidence.
Meindert Boysen, director of the NICE Centre for Health Technology Evaluation, said: “The committee heard from the patient experts that people with squamous non-small-cell lung cancer often have a poor quality of life, and that treatments that have the potential to extend life would be of great importance.
“Pembrolizumab combination therapy is a promising treatment option for these patients who currently have very few. We are therefore pleased to be able to use the flexibility provided by the Cancer Drugs Fund to recommend it while further data on its clinical effectiveness is collected.”
Pembrolizumab combination therapy will be available to NHS patients in England immediately. Subject to appeal, NICE’s final guidance will be published next month (September).
Pembrolizumab is given every 3 weeks by intravenous infusion. The 200 mg infusion has a list price of £5,260, but the company has offered the NHS a confidential discount.
