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NICE endorses afatinib for NSCLC but says no to pemetrexed

The National Institute for Health and Care Excellence has today (23 April 2014) issued final and draft guidance governing the availability of four new cancer drugs on the NHS in England and Wales.

Giotrif pack short

Afatinib, an epidermal growth factor receptor tyrosine kinase inhibitor, is being made available via a patient access scheme

It has given the go-ahead for afatinib (Giotrif) for the treatment of non-small-cell lung cancer. The decision means that lung cancer patients will now have a third targeted treatment option available to them on the NHS.

The drug – an epidermal growth factor receptor tyrosine kinase (EGFR-TK) inhibitor – is being made available via a patient access scheme, agreed by the Department of Health and the drug’s manufacturer Boehringer Ingelheim.

The treatment will be an option for patients with non-small-cell lung cancer that is either locally advanced or has spread to other parts of the body and whose tumours test positive for an EGFR-TK mutation.

NICE has also announced in final guidance that it will not be recommending the use of pemetrexed (Alimta; Eli Lilly) on the NHS for the treatment of non-squamous non-small-cell lung cancer because it does not consider the treatment to be cost effective.

Although pemetrexed was clinically effective when given following induction treatment with cisplatin, it was not justifiable on cost grounds, said NICE chief executive Sir Andrew Dillon.

He said: “It is disappointing not to be able to recommend pemetrexed but we can only recommend treatments which are both clinically and cost effective.”

NICE estimates that the cost of pemetrexed per quality adjusted life year (QALY) gained is around £74,500.

Separately, NICE has recommended that patients newly diagnosed with multiple myeloma who are eligible for high-dose chemotherapy and are suitable for a bone marrow transplant should have access to bortezomib (Velcade; Janssen) on the NHS. It will be available as a first treatment before transplant, according to the recommendations.

Another cancer medicine — which is already available though the Government’s Cancer Drugs Fund — will not be made routinely available on the NHS, according to draft guidance.

Trastuzumab emtansine (Kadcyla; Roche) is an option for women with HER2-positive breast cancer that has spread to other parts of the body, cannot be surgically removed and has stopped responding to initial treatment.

NICE calculates that the treatment can cost more than £90, 000 per patient and says it is too expensive to justify it being routinely available on the NHS.

Sir Andrew expressed disappointment that Roche had not reduced the NHS price, adding: “[T]he reality is that given its price and what it offers to patients, it will displace more health benefit which the NHS could achieve in other ways, than it will offer to patients with breast cancer.”

Final NICE guidance on trastuzumab emtansine is expected in August 2014.

Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2014.11137702

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