Pembrolizumab is recommended, within its marketing authorisation, as an option for neoadjuvant treatment with platinum-based chemotherapy, then continued alone as adjuvant treatment, for resectable non-small-cell lung cancer (NSCLC) with a high risk of recurrence in adults. Pembrolizumab is only recommended if the company provides it according to the commercial arrangement.
Usual treatment for resectable NSCLC with a high risk of recurrence in adults is nivolumab with chemotherapy, then surgery. A resectable tumour is one that can be removed surgically.
Clinical trial evidence shows that, compared with placebo, pembrolizumab with platinum-based chemotherapy before surgery (neoadjuvant) then pembrolizumab alone after surgery (adjuvant) decreases the likelihood of:
an event that would stop people having surgery (for example, the cancer getting worse), and
the cancer coming back after surgery.
It also shows that people having pembrolizumab live longer than those having placebo.
Pembrolizumab has not been directly compared in a clinical trial with neoadjuvant nivolumab with chemotherapy. An indirect comparison suggests that pembrolizumab may reduce the likelihood of the cancer getting worse or coming back after surgery compared with neoadjuvant nivolumab, but this is uncertain.
The cost-effectiveness estimates for pembrolizumab are within the range that NICE considers an acceptable use of NHS resources. So, pembrolizumab is recommended.