Lung cancer immunotherapy drug approved for England

A lung cancer immunotherapy drug has been made widely available on the NHS in England after a price deal was reached. 

Pembrolizumab (Keytruda) had been deemed too expensive to be routinely available according to rules recently introduced by NHS England. But an agreement has been made with the manufacturer to reduce the cost. 

It will be available for patients with untreated non-small-cell lung cancer that has spread to other parts of the body, when their cancer tests positive for a molecule called PD-L1. 

Emlyn Samuel, Cancer Research UK’s head of policy development, said: “This decision is great news for people affected by this type of cancer. We welcome the fact that NHS England and the company have been able to come to a deal and avoid delaying the drug’s availability for patients.”

How does pembrolizumab work?

Pembrolizumab is a type of immunotherapy, which stimulates the body’s immune system to fight cancer cells. 

Cancer cells often have high levels of a molecule called PD-L1, which binds the PD-1 molecule on T-cells and stops them from working. Pembrolizumab blocks this interaction, allowing T-cells to target and kill cancer cells.

On average patients taking pembrolizumab survive an extra 16 months, compared to those given standard treatment. 

What are the rules?

When new drugs cost more than £20 million a year, NHS England now has the option to delay funding and negotiate a lower price with the manufacturer. Pembrolizumab is the first drug to break this new budget impact threshold. 

At its original price pembrolizumab would have cost around £84,000 per patient for a course of treatment NHS England and the manufacturer, MSD, have agreed a confidential arrangement for a new price. 

The National Institute for Health and Care Excellence (NICE), the body that approves drugs in England, then recommended it to be widely available on the NHS. 

Pembrolizumab was previously available through the early access to medicines scheme. It was theno one of the first drugs to be made available through the new Cancer Drugs Fund (CDF), while the findings of a new study that would answer uncertainties around the drug’s effectiveness were collected.

Simon Stevens, NHS England chief executive, said: “This is another milestone in our rapidly improving modern NHS cancer care. This win-win deal for patients and taxpayers brings genuine innovation and proven survival gains to cancer patients across England.” 

Meindert Boysen, director of the NICE centre for health technology evaluation, said: “We have to make sure that any new treatment we recommend works well and is a good use of NHS resources. Recent changes to the CDF mean we have more flexibility in our process so we can grant early access to promising drugs whilst more data is gathered on their long-term benefits.

“Pembrolizumab is one of the first new cancer drugs to benefit from this flexible approach and it can now be used routinely in the NHS. In the past 20 years there have been few improvements for people with this type of lung cancer so we are pleased to recommend routine access to pembrolizumab on the NHS.”