NICE recommends Roche's Tecentriq combo for certain lung cancer patients

Certain patients with untreated lung cancer in England have a new treatment option after cost-effectiveness body NICE made a draft recommendation that the NHS should fund Roche’s cocktail involving its immunotherapy Tecentriq.

The combination of Tecentriq (atezolizumab), Avastin (bevacizumab), plus carboplatin and paclitaxel chemotherapy has been recommended as an option for metastatic non-squamous non-small cell lung cancer in adults with untreated disease whose PD-L1 expression is low or negative.

In the final draft guidance NICE has also okayed funding for those with EGFR or ALK-positive mutations, who have failed on a previous targeted therapy, in a decision that could make the treatment available to around 4,800 patients.

Roche has developed the combination to compete with Merck & Co’s immunotherapy Keytruda (pembrolizumab), which NICE has recommended for interim funding in combination with chemotherapy in untreated NSCLC patients with no EGFR or ALK mutations.

The positive recommendation follows an improved confidential discount to the prices of Tecentriq and Avastin offered by Roche.

It is also made on the basis that treatment with Tecentriq and Avastin is stopped at 2-years (or earlier if the disease worsens) to reflect the fact that the cost-effectiveness evidence was limited to 2-years of treatment and the best length of treatment is unknown.

NICE made the recommendation based on data from the IMpower 150 trial that suggests that people having Tecentriq and Avastin, plus carboplatin and paclitaxel live longer than those having the standard treatment – pemetrexed plus carboplatin or cisplatin, with or without pemetrexed maintenance. It also suggests that they live for longer before their condition worsens.

But NICE’s committee was unable to make a recommendation on the use of the combination in untreated PD-L1-positive metastatic NSCLC in people whose PD-L1 tumour proportion score is at least 50% because no cost-effectiveness analyses comparing this with the current treatment for this type of NSCLC (pembrolizumab monotherapy) were provided.

Consultees, including the company, patient groups and healthcare professionals, can appeal against the draft recommendations. If there are no appeals, NICE will publish final guidance to the NHS in June.