NICE backs Takeda’s Alunbrig in second-line lung cancer

NICE has published final draft guidance recommending regular NHS funding in England for Takeda’s Alunbrig (brigatinib), for ALK-positive advanced non-small cell lung cancer, in patients already treated with Pfizer’s Xalkori.

The decision from the cost-effectiveness body follows an earlier draft appraisal that said the drug was not cost-effective in this use.

A further price cut from the company and further clarifications about its economic model mean it is now recommended for routine use in the NHS, NICE said.

NICE’s independent committee also took into account that future treatments will be limited for this population because Xalkori is no longer considered first-line treatment for ALK-positive disease.

People with this form of lung cancer are currently offered Novartis’ Zykadia (ceritinib) as a second line treatment. People taking ceritinib survive for 18 months on average, based on evidence from the ASCEND-5 trial.

Results from the ALTA trial showed that people taking brigatinib whose disease had progressed on crizotinib could live an average of 34 months. Brigatinib is also less toxic than ceritinib, today’s final appraisal document (FAD) says.

Fewer than 50 people in England will be eligible, and that number will reduce further because crizotinib is no longer considered the first-line treatment.

Also known as Alunbrig, brigatinib is taken as a daily tablet. Its proposed list price is £4,900 for 28 x 180 mg tablets, but under its commercial agreement manufacturer Takeda will provide it to the NHS at a confidential discounted price.

Pending appeals from stakeholders, final guidance will be published next month.

Last year, Alunbrig beat Xalkori on progression free survival in a trial comparing the two drugs in patients with untreated ALK-positive non-small-cell lunger cancer (NSCLC).

An interim analysis showed Alunbrig significantly improved intracranial progression-free survival compared with Xalkori, in all patients and those with brain metastases at the start of the trial.

Among patients with brain metastases at baseline, Alunbrig reduced the risk of progression in the brain or death by 73%.

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