Immunotherapy treatment recommended for advanced small cell lung cancer 

A new immunotherapy treatment has been recommended by the National Institute for Health and Care Excellence (NICE) for some adults with small cell lung cancer.  

Atezolizumab (Tecentriq), used in combination with standard chemotherapy drugs, will be made available on the NHS in England for people with small cell lung cancer that’s spread beyond a single area and can’t be treated with radiotherapy ­– otherwise known as extensive stage cancer. 

Following an initial rejection by NICE in January, a new price offer from the manufacturer has allowed the therapy to be approved under the extra flexibilities allowed for drugs considered a life-extending treatment at the end of life.    

Around 2,400 people in England have this type of lung cancer, of whom around 1,200 people will be eligible for the new treatment, according to NICE. 

Emlyn Samuel, Cancer Research UK’s head of policy, called the decision “great news”, giving some cancer patients access to immunotherapy treatment for the first time.  

Awakening the immune system  

Atezolizumab works by blocking a molecule on the surface of tumour cells that interacts with immune cells, boosting the immune system’s ability to  attack cancer cells. 

The current standard of care for patients with extensive stage small cell lung cancer is a combination of the chemotherapy drugs carboplatin and etoposide. However, patients told NICE that the current treatment offers a poor prognosis. 

Meindert Boysen, deputy chief executive officer and director of the Centre for Health Technology Evaluation at NICE, said atezolizumab could offer new hope to patients with few treatment options available, giving them “valuable time to spend with their loved ones”. 

The trial 

Clinical trial evidence suggests adding atezolizumab to current chemotherapy treatment gives patients more time before their cancer gets bigger, and improves overall survival.  

In trial involving 403 patients, patients taking atezolizumab lived for an average of 12.3 months, compared with 10.3 months in group taking a placebo and chemotherapy.  

But the long-term benefits of the combination are unclear, as clinical trial data did not suggest a significant survival benefit from adding atezolizumab beyond 30 months.  

Life-extending treatment 

After additional data analyses and an updated commercial discount, atezolizumab now meets the criteria to be considered cost-effective for NHS use. 

“This is a fast-progressing type of lung cancer, but clinical trial evidence suggests this drug combination could give patients more time before their cancer gets significantly bigger, and may help them live longer,” said Samuel. 

“Cancer doesn’t stop because of a pandemic, so we’re pleased that today’s decision will offer new hope to some people affected by this disease.” 

NICE decisions are usually adopted in Wales and Northern Ireland as well as England, so the decision is likely to affect patients in all 3 nations. Scotland has a separate process for reviewing which drugs should be available on the NHS.