NHS Rejects Lung Cancer Treatment Combination
A treatment combination for non-squamous non-small cell lung cancer has been provisionally rejected for people with certain types of lung cancer on the NHS in England.
The four-drug combination includes atezolizumab (Tecentriq), bevacizumab (Avastin), and the two chemotherapies carboplatin (Paraplatin) and paclitaxel (Taxol). It was being assessed for patients with advanced disease or those with EGFR- and ALK-positive tumors. Patients with these cancers are currently given a combination of chemotherapy drugs.
In a clinical trial (Impower150), the combination with atezolizumab was shown to significantly prolong progression-free survival (8.3 months vs 6.8 months; HR, 0.59; 95% CI: 0.50, 0.69; P < .0001) and overall survival (19.8 months vs 14.9 months; HR, 0.76; 95% CI: 0.63, 0.93) compared with patients who received the combination without atezolizumab. However, the National Institute for Health and Care Excellence (NICE) determined that, because the study did not compare the treatment combination with the current standard of care, its overall benefits are unknown.
NICE also disagreed with how the overall survival for EGFR/ALK-positive patients was calculated, noting that the trial was not stratified by EGFR/ALK-positive status, and some baseline characteristics were imbalanced between the arms. Additionally, the numbers of patients in this population in either treatment arm were small.
Adverse events were slightly worse in the group taking the four-drug combination. These patients reported more cases of rash, loss of appetite, and fever, among others.
The committee concluded that, although the drug combination met the criteria for a life-extending treatment at the end of life, “the most plausible cost-effectiveness estimates…are above what NICE normally considers acceptable for an end-of-life treatment,” they wrote in a report.
Cancer Research UK's policy manager, Rose Gray, said it was a shame that NICE provisionally rejected this treatment. “Lung cancer survival is lower than many other types of cancer and so it's crucial that we find new, effective treatment options for people with this disease.”
The decision will be reviewed by NICE at the end of March.—Kara Rosania
