An area of lung tissue showing small cell cancer on the left and normal tissue on the right. Credit: Steve Bagley An area of lung tissue showing lung cancer on the left.
A combination of immunotherapy and chemotherapy has been rejected by the National Institute for Health and Care Excellence (NICE) for some adults with small cell lung cancer.
The combination treatment would be an option for adults with untreated small cell lung cancer that’s spread beyond a single area and couldn’t be treated with radiotherapy, otherwise known as extensive stage cancer.
Adding the immunotherapy drug atezolizumab (Tecentriq) to standard chemotherapy drugs has been shown to give patients more time before their cancer gets bigger and can improve survival. But NICE concluded there wasn’t enough evidence that these benefits are sustained in the long run, making it hard to say if the drug would be cost effective.
Rose Gray, policy manager at Cancer Research UK, said the decision will be “hugely disappointing” for people affected by this type of lung cancer.
Giving people more time
The new treatment combined immunotherapy drug atezolizumab with chemotherapy drugs carboplatin and etoposide.
Atezolizumab works by reawakening the immune system. It blocks a molecule on the surface of tumour cells that interacts with immune cells.
Clinical trial evidence suggests that adding atezolizumab to standard chemotherapy treatment could improve survival for people with this highly aggressive type of lung cancer. People taking the combination lived for 12.3 months on average, compared with 10.3 months for those taking chemotherapy alone.
Long term benefits are unclear
However, NICE highlighted uncertainties in the clinical trial results.
Adding atezolizumab to chemotherapy improved how long patients were surviving their disease on average. But patients taking atezolizumab were no more likely to have survived their cancer 30 months after the start of treatment than those taking standard chemotherapy drugs.
NICE said this made it unclear if the survival benefit to patients from taking atezolizumab would be sustained in the long run.
And the patients who took part in the trial were fitter than people typically treated on the NHS, so it’s not clear if the trial results could be generalised to the wider population.
These uncertainties made it hard for NICE to model whether adding atezolizumab to chemotherapy treatments would offer value for money to the NHS. As such, NICE has decided not to recommend the combination treatment.
Decisions made by NICE are usually followed in Wales and Northern Ireland too. Whereas decisions about what drugs the NHS should fund in Scotland are made separately by the Scottish Medicines Consortium.
The decision will be reviewed in February.
“Patients told NICE there was a real need for new treatments for this disease type,” says Gray. “We urge NICE, NHS England and the drugs’ manufacturer to work together to agree a deal which will allow the treatment to be approved.”
NICE (2019) Atezolizumab with carboplatin and etoposide for untreated extensive-stage small-cell lung cancer [ID1504]