The National Institute for Health and Care Excellence (NICE) have recommended AstraZeneca's durvalumab (brand name Imfinzi▼) as an option for single therapy in treating locally advanced, unresectable (cannot be surgically removed) non-small-cell lung cancer (NSCLC).
The treatment is approved for use in adults whose tumours produce a protein called PD‑L1 on at least 1% of tumour cells and whose disease has not progressed after platinum-based chemoradiation if:
- they have had concurrent platinum-based chemoradiation
- the conditions in the managed access agreement are followed
Funding for the treatment will covered by the Cancer Drugs Fund in England.
Managed access schemes are agreements between the manufacturer and the NHS, usually specifying a set of conditions under which reimbursement for the medicine will be made.
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Why the NICE committee made these recommendations
Locally advanced NSCLC that is unresectable (cannot be surgically removed) is usually treated with platinum-based chemoradiation. After this there are no treatment options to delay or stop the disease progressing. Durvalumab is a possible treatment at this stage.
The main evidence for durvalumab comes from a clinical trial (called PACIFIC). This suggests that durvalumab is more effective than standard care in delaying disease progression after concurrent platinum-based chemoradiation (chemotherapy and radiation at the same time). But PACIFIC is ongoing, so there is not yet enough evidence about:
- how long the treatment effect of durvalumab lasts
- how many people taking durvalumab would live without their disease progressing
Durvalumab has the potential to be cost effective compared with standard care, but more evidence from the ongoing trial is needed to address the uncertainties. Therefore, it is recommended for use in the Cancer Drugs Fund.
About Imfinzi (source EMA)
Imfinzi is a medicine used to treat a type of lung cancer called non-small cell lung cancer (NSCLC).
Imfinzi is used in adult patients with advanced cancer that cannot be removed by surgery but is not getting worse after treatment with radiation and platinum-based chemotherapy (medicines to treat cancer). Imfinzi is used specifically when the tumour produces a protein known as PD-L1.
The active substance in Imfinzi, durvalumab, is a monoclonal antibody, a type of protein designed to recognise and attach to a protein called PD-L1, which is present on the surface of many cancer cells.
PD-L1 acts to switch off immune cells that would otherwise attack the cancer cells. By attaching to PD- L1 and blocking its effects, Imfinzi increases the ability of the immune system to attack the cancer cells and thereby slow down the progression of the disease.
Imfinzi was first made available in the EU in 2018. It is manufactured by AstraZeneca.
European Medicines Agency website page for Imfinzi
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© NICE  Durvalumab for treating locally advanced unresectable non-small-cell lung cancer after platinum-based chemoradiation Available from: See Link below. All rights reserved. Subject to Notice of rights
NICE guidance is prepared for the National Health Service in England. All NICE guidance is subject to regular review and may be updated or withdrawn. NICE accepts no responsibility for the use of its content in this product/publication.
The information provided by NICE was accurate at the time this article was issued.
NICE guidance: Durvalumab for treating locally advanced unresectable non-small-cell lung cancer after platinum-based chemoradiation
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