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    Has all of the relevant evidence been taken into account?
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    Are the summaries of clinical and cost effectiveness reasonable interpretations of the evidence?
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    Are the recommendations sound and a suitable basis for guidance to the NHS?
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    Are there any aspects of the recommendations that need particular consideration to ensure we avoid unlawful discrimination against any group of people on the grounds of race, gender, disability, religion or belief, sexual orientation, age, gender reassignment, pregnancy and maternity?
The content on this page is not current guidance and is only for the purposes of the consultation process.

1 Recommendations

1.1 Atezolizumab with carboplatin and etoposide is not recommended, within its marketing authorisation, for untreated extensive-stage small-cell lung cancer in adults.

1.2 This recommendation is not intended to affect treatment with atezolizumab, with carboplatin and etoposide, 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 clinician consider it appropriate to stop.

Why the committee made these recommendations

People with untreated extensive-stage small-cell lung cancer have carboplatin and etoposide chemotherapy as their first treatment. Clinical trial evidence is in people with good performance status (they are more able to do daily tasks and ordinary activities than those with poorer performance status). It suggests that atezolizumab with chemotherapy could help people to live longer without their disease progressing, and to live for longer compared with chemotherapy alone. However, people in the NHS in England are likely to have poorer performance status than people in the trial.

There are uncertainties about how long people having atezolizumab live. These include how well the modelled curves fit the trial data and how well they predict long-term survival, with more flexible models fitting the trial data better. So, the cost-effectiveness estimates comparing atezolizumab and chemotherapy with chemotherapy alone are highly uncertain.

Atezolizumab meets NICE's criteria to be considered a life-extending treatment at the end of life. Even so, the cost-effectiveness estimates for atezolizumab with chemotherapy are higher than what is considered a cost-effective use of NHS resources. So, atezolizumab with carboplatin and etoposide is not recommended for untreated extensive-stage small-cell lung cancer.