NICE clears front-line NHS use for Pfizer’s lung cancer drug Vizimpro

Pfizer has stolen a march on rival AstraZeneca in the first-line non-small cell lung cancer category, after NICE backed the use of its EGFR inhibitor Vizimpro for NHS use.

The once-daily pill will now be routinely available for adults with locally advanced or metastatic non-small cell lung cancer (NSCLC), who have tested positive for the epidermal growth factor receptor (EGFR) mutation. Earlier, NICE rejected the drug on the grounds that it wasn’t a cost-effective use of NHS resources.

AZ has not been so lucky, with the cost-effectiveness agency turning down its EGFR inhibitor Tagrisso (osimertinib) for the same indication, although the company has said it intends to appeal the decision.

Pfizer has offered a discount on Vizimpro (dacomitinib), which was approved by the EMA in April and in the US last September. Its list price in the UK is £2,703 for a 30-day pack of capsules, but the agreed reduction is confidential.

In a statement, NICE said Pfizer’s “responsible pricing” had allowed its appraisal committee to reconsider its initial decision.

Both Vizimpro and Tagrisso were turned down by the agency in April after an initial assessment, with the committee deciding neither drug offered enough extra benefit to patients when compared with existing treatments to be value for money.

“Our committee acknowledged that dacomitinib had the potential to extend life for people with this type of lung cancer more than existing treatments currently available on the NHS,” said Meindert Boysen, director of the Centre for Health Technology Evaluation at NICE.

Company estimates are that around 1,477 people in England will be eligible for treatment with Vizimpro every year, according to the agency.

Health services in Wales and Northern Ireland usually follow NICE recommendations too, so the drug will likely be available there as well, according to Cancer Research UK.

The charity welcomed the green light for Vizimpro but said the Tagrisso decision was “disappointing”, particularly as AZ’s drug seems to offer some efficacy advantages and fewer side effects.

For now, the decision puts Pfizer UK in the driving seat for first-line EGFR-positive NSCLC therapy in England.

The company’s oncology director, Olivia Ashman, said: “Lung cancer remains a challenging condition to treat and we are pleased that clinicians managing patients with EGFR-mutated NSCLC will now have access to this important medicine.”

NICE has already recommended three other EGFR inhibitors for previously-untreated EGFR-positive NSCLC, including AZ's Iressa, Boehringer Ingelheim’s Giotrif and Roche's Tarceva, although these are considered less effective than the newer agents.

The agency’s guidance says people who took Vizimpro had longer overall survival rates than those who took Iressa – 34.1 months compared with 26.8 months – and Pfizer’s drug also increased the length of time before the disease worsened by around five months.

Vizimpro had a higher incidence of side effects than Iressa, however, so a lower dose may be needed, according to NICE.