NICE recommends pembrolizumab for advanced stomach cancers

The National Institute for Health and Care Excellence (NICE) has recommended the use of the immunotherapy drug pembrolizumab (also known as Keytruda) as an option for people with advanced gastric cancer.

The recommendation is for those with advanced gastric or gastro-oesophageal cancers that are inoperable or have spread to other parts of the body, and express a protein called PD-L1.

The drug will be given alongside the standard chemotherapy for advanced stomach and gastric or gastro-oesophageal junction cancer.

What are stomach cancers?

Stomach cancer, also known as gastric cancer, is when abnormal cells in the stomach grow and divide uncontrollably. It affects around 6,600 people in the UK each year and is more common in older people, with around half of new cases (49%) occurring in people aged 75 and over.

The gastro oesophageal junction is where your food pipe (oesophagus) joins your stomach. Cancer that starts here is called gastro oesophageal junction (GOJ) cancer, or also known as oesophago gastric junctional cancer. It can sometimes be difficult to tell the difference between stomach, oesophageal and GOJ cancers. But GOJ are a separate type of cancer which behaves differently to those in the stomach and oesophagus.

How does pembrolizumab work?

Pembrolizumab is a type of immunotherapy drug called a checkpoint inhibitor. It’s administered by a drip into the bloodstream (intravenously) and stimulates the body’s immune system to fight cancer cells.

It targets and blocks a protein called PD-1 on the surface of immune cells, called T-cells. PD-1 acts as a kind of ‘brake’ to keep the body’s immune system under control. Cancer cells that express PD-L1 can bind to PD-1 on T-cells to prevent them from killing cancer cells. So, by blocking PD-1, pembrolizumab allows the T-cells to find and kill cancer cells.

NICE now recommends it is given with chemotherapy as a first line of treatment for people with stomach cancers that express PD-L1 and have spread or cannot be surgically removed.

The benefits of pembrolizumab

Pembrolizumab has already been approved as a treatment for other cancers, including breast cancer, cervical cancer, bowel cancer and lung cancer.

This decision was made based on the results of, KEYNOTE-859, a clinical trial which found that Pembrolizumab plus chemotherapy delayed cancer progression, increased the proportion of people whose cancer responded to treatment and increased overall survival compared to chemotherapy alone.

Dr Elizabeth Smyth, a consultant in gastrointestinal oncology at Cambridge University Hospitals NHS Foundation Trust, said that the trial findings were “practice-changing” and that the results demonstrate “very consistently” that checkpoint inhibition plus chemotherapy can improve overall survival in people whose cancers have higher levels of PD-L1 expression.

NICE decisions apply to England and are usually adopted in Wales and Northern Ireland. Scotland has a different process for deciding which drugs can be used on the NHS.