1 Recommendations

1.1

Cemiplimab with platinum-based chemotherapy can be used as an option for untreated non-small-cell lung cancer (NSCLC) in adults:

if they would otherwise be offered pembrolizumab with platinum-based chemotherapy, and
when the cancer:
- is locally advanced and not suitable for definitive chemoradiation, or is metastatic
- has PD-L1 in 1% or more of the tumour cells, and
- has no EGFR, ALK or ROS-1 aberrations.
  
  Cemiplimab with platinum-based chemotherapy can only be used if the company provides cemiplimab according to the commercial arrangement.

1.2

This recommendation is not intended to affect treatment with cemiplimab with platinum-based chemotherapy that was started in the NHS before this guidance was published. People having treatment outside this recommendation may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS healthcare professional consider it appropriate to stop.

What this means in practice

Cemiplimab with platinum-based chemotherapy must be funded in the NHS in England for the condition and population in the recommendations, if it is considered the most suitable treatment option. Cemiplimab with platinum-based chemotherapy must be funded in England within 90 days of final publication of this guidance.

There is enough evidence to show that cemiplimab with platinum-based chemotherapy provides benefits and value for money, so it can be used routinely across the NHS in this population.

NICE has produced tools and resources to support the implementation of this guidance.

Why the committee made these recommendations

This rapid review considers a revised commercial arrangement and an updated cost-effectiveness analysis for cemiplimab with platinum-based chemotherapy for untreated advanced NSCLC (NICE technology appraisal guidance 1108).

Usual treatment for advanced NSCLC includes chemotherapy alone, immunotherapy alone, or immunotherapy plus chemotherapy. Cemiplimab and pembrolizumab are types of immunotherapy.

For this evaluation, the company asked for cemiplimab plus chemotherapy to be considered only for people who would otherwise be offered pembrolizumab plus chemotherapy. This reflects that most people in clinical practice would be offered immunotherapy plus chemotherapy, but this does not include everyone that cemiplimab is licensed for.

Clinical trial evidence shows that cemiplimab plus chemotherapy increases how long people have before their cancer gets worse and how long they live compared with placebo plus chemotherapy. Cemiplimab plus chemotherapy has not been directly compared in a clinical trial with pembrolizumab plus chemotherapy. The results of indirect comparisons are uncertain, but they suggest that cemiplimab and pembrolizumab are likely to have similar benefits.

The costs for cemiplimab plus chemotherapy are similar to or lower than those for pembrolizumab plus chemotherapy. So, cemiplimab plus chemotherapy can be used.