The National Institute for Health and Care Excellence (NICE) have published draft guidance recommending that Roche's cancer medicine atezolizumab, brand name Tecentriq▼, for the treatment of a type of lung cancer called non-squamous, non-small cell lung cancer (NSCLC).
The NICE recommendation is that atezolizumab plus other medicines, bevacizumab, carboplatin and paclitaxel is
recommended as an option for metastatic non-squamous, non-small-cell lung cancer (NSCLC) in adults:
- who have not had treatment for their metastatic NSCLC before and whose PD-L1 tumour proportion score is between 0% and 49% or
- when targeted therapy for epidermal growth factor receptor (EGFR)-positive or anaplastic lymphoma kinase (ALK)-positive NSCLC has failed
NICE also state that atezolizumab and bevacizumab should be stopped after 2 years of uninterrupted treatment, or earlier if the disease progresses.
The recommendation also requires that the company provides atezolizumab and bevacizumab according to the commercial arrangements which reduces the cost of the medicine to the NHS.
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Why the NICE committee made these recommendations
Pemetrexed plus carboplatin or cisplatin, with or without pemetrexed maintenance, is the current treatment for:
- untreated metastatic non-squamous NSCLC (with no EGFR- or ALK positive mutations) with a PD-L1 tumour proportion score between 0% and 49% and
- metastatic non-squamous EGFR- or ALK-positive NSCLC when targeted therapy is either not an option or has failed.
Pembrolizumab monotherapy is the current treatment for untreated metastatic non-squamous NSCLC with a PD-L1 tumour proportion score of at least 50%.
An indirect comparison of studies suggests that people having atezolizumab plus bevacizumab, carboplatin and paclitaxel live longer than those having pemetrexed plus carboplatin or cisplatin, with or without pemetrexed maintenance. This comparison also suggests that they live for longer before their condition worsens.
Atezolizumab plus bevacizumab, carboplatin and paclitaxel meets NICE’s criteria to be considered a life-extending treatment at the end of life. There is uncertainty about the company’s long-term survival estimates, especially for people with EGFR- or ALK-positive NSCLC.
But including the most plausible assumptions and the commercial arrangements, the cost-effectiveness estimates are within what NICE normally considers acceptable for an end-of-life treatment. Therefore, atezolizumab plus bevacizumab, carboplatin and paclitaxel is recommended for metastatic non-squamous NSCLC that is untreated (with no EGFR- or ALK-positive mutations) and when the PD-L1 tumour proportion score is between 0% and 49%, or that is EGFR- or ALK-positive and for which targeted therapy has failed.
About Tecentriq (source EMA)
Tecentriq is a cancer medicine for treating urothelial carcinoma (a cancer of the bladder and urinary system) and a type of lung cancer called non‑small cell lung cancer.
Tecentriq is used when these cancers are advanced or have spread to other parts of the body. For urothelial carcinoma, the medicine is for patients who have tried platinum chemotherapy before or are ineligible for treatment with cisplatin.
Patients with non‑small cell lung cancer should first have had chemotherapy and those with certain genetic mutations (changes) that respond to targeted treatments should have those treatments before receiving Tecentriq.
The active substance in Tecentriq, atezolizumab, 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 reducing its effects, Tecentriq increases the ability of the immune system to attack the cancer cells and thereby slow down the progression of the disease.
Tecentriq was first made available in the EU in 2017. It is manufactured by Roche.
European Medicines Agency website page for Tecentriq
© NICE  Atezolizumab in combination for treating advanced non-squamous non-small-cell lung cancer 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 draft guidance: Atezolizumab in combination for treating advanced non-squamous non-small-cell lung cancer
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