NHS will roll out ‘lifeline’ endometrial cancer regimen

The NHS has agreed a pair of commercial deals with Merck & Co/MSD and Eisai that will allow hundreds of women with advanced endometrial cancer to get access to life-extending combination therapy.

A regimen based on MSD’s PD-1 inhibitor Keytruda (pembrolizumab) and Eisai’s tyrosine kinase inhibitor Lenvima (lenvatinib) will now become a treatment option for between 500 and 750 women each year, after previously being rejected by cost-effectiveness agency NICE.

It also brings the UK as a whole into line with Scotland, which backed the combination for advanced or recurrent endometrial cancer in October 2022.

When diagnosed and treated early, endometrial cancer can often be cured with surgery. However, for patients with more advanced disease there are few treatment options and their outlook is very poor. It is the fourth most common cancer affecting women in the UK.

Thanks to the new commercial arrangement, NICE is due to finalise its recommendation that the combination be funded by the NHS immediately, and offered to women whose endometrial cancer has progressed despite prior chemotherapy, and who are not eligible for curative surgery or radiotherapy.

At the moment, according to NICE, there is no standard treatment for this patient group and, while the data for the Keytruda/Lenvima combination from the KEYNOTE-775 is a little uncertain because it relied on some therapies not used in the UK, the agency has concluded that the results are “generalisable” to the NHS.

In the study, Keytruda plus Lenvima cut the risk of death by 38% compared with placebo in advanced, metastatic, or recurrent endometrial cancer patients who had previously been treated with chemotherapy, giving patients on average an additional seven months of life.

The news was hailed by Professor Emma Crosbie, chair of trustees for the Peaches Womb Cancer Trust, who said that “every year, many people are facing a diagnosis of advanced or recurrent womb cancer, and the frightening reality of very few treatment options that can improve their survival and quality of life.”

“Those affected by womb cancer deserve more treatment options, but we hope that this is just the first step towards wider availability of more effective treatment options for those affected by this devastating cancer,” she added.

Heart failure, Crohn’s disease decisions

In a busy day for NICE, the health technology assessment (HTA) agency also gave a positive opinion on AstraZeneca’s SGLT2 inhibitor Forxiga (dapagliflozin) as an option for adults with symptomatic chronic heart failure with preserved or mildly reduced ejection fraction.

Forxiga becomes the first NICE-recommended treatment for this form, which affects around half of the 550,000 people in England with heart failure.

Meanwhile, AbbVie’s JAK inhibitor Rinvoq (upadacitinib) was backed as a treatment for moderately to severely active Crohn’s disease, the first drug in the class to be made available for this indication in England and Wales.