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Lung cancer immunotherapy approved for NHS patients in England

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by Cancer Research UK | News

28 March 2019

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An immunotherapy drug will be made available on the NHS in England for certain people with lung cancer. 

The National Institute for Health and Care and Excellence (NICE) recommended durvalumab (Imfinzi) for people with advanced non small cell lung cancer who can’t have surgery. 

NICE specified that patients’ cancers must also test positive for a molecule called PD-L1. And patients must also have previously had chemotherapy and radiotherapy at the same time, so-called concurrent therapy.

Rose Gray, policy manager at Cancer Research UK, said: “This decision is fantastic news, as it means some patients with this type of lung cancer will have access to a new treatment, at a stage of the disease where no drug was available before.” 

The treatment, which reawakens the patient’s immune system, will be available via the Cancer Drugs Fund while more data is collected on its long-term effectiveness.

Gray said patients and doctors told NICE about the lack of alternate treatments, adding “it’s great that NHS England, NICE and the company have worked together to reach this deal.” 

The clinical trial

The approval comes after a clinical trial showed durvalumab extended the time before patients’ lung cancers got worse after chemotherapy and radiotherapy treatment. 

The trial involved 709 people, with 473 receiving durvalumab and the rest receiving a dummy drug (placebo). 

Those who took durvalumab lived 16.8 months on average before their cancer got worse, compared with 5.6 months for those taking the placebo. 

Around 44 in 100 people treated with the immunotherapy had not seen their disease get worse 18 months after treatment, compared with around 27 in 100 people who took the placebo.  

Reported side effects did not differ greatly between groups. Lung infections (pneumonia) and a reduced number of red blood cells (anaemia), which can cause fatigue, were some of the most common side effects reported from both groups.

How does durvalumab work?

Durvalumab is an immunotherapy drug that helps reawaken the patient’s immune system. It blocks molecules on the surface of tumour cells that can switch off immune cells. 

The molecule it targets is called PD-L1. Treatment releases the brakes on immune cells so they can attack cancer cells. 

More evidence needed

Gray said durvalumab will be paid for through the Cancer Drugs Fund because NICE wants more evidence on how much extra time it offers patients before their cancer spreads.

“By recommending it for the Cancer Drugs Fund, patients will have access to it while more data is collected.”

A spokesperson for NICE, Meindert Boysen, said they look forward to seeing more evidence on its effectiveness. 

“After relatively few developments in the past two decades for people with this type of lung cancer, this decision will be particularly welcome to those with the condition, their families and the healthcare staff and experts working with them.”

Not for everyone with this cancer type

Gray added however that “many patients with this type of cancer won’t be able to have the drug, based on how their radiotherapy and chemotherapy was given.” 

The final draft guidance only applies to a specific group of patients, those who have previously had chemotherapy and radiotherapy at the same time. This is because this was the approach tested in the trial. 

Patients are currently more likely to receive chemotherapy first in England, followed by radiotherapy (known as sequential therapy). 

“Research is still being done to see if people who have their radiotherapy and chemotherapy at separate times would also benefit from this drug. We urge NICE and the drug company to evaluate this data as soon as possible,” said Gray.

NICE decisions are also adopted by Wales and Northern Ireland so durvalumab should be available for eligible patients there too.