1.1 Atezolizumab with carboplatin and etoposide is recommended as an option for untreated extensive-stage small-cell lung cancer in adults, only if:
they have an Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1, and
the company provides atezolizumab according to the commercial arrangement.
1.2 When using ECOG performance status, healthcare professionals should take into account any physical, sensory or learning disabilities, or communication difficulties that could affect ECOG performance status and make any adjustments they consider appropriate.
1.3 These recommendations are not intended to affect treatment with atezolizumab that was started in the NHS before this guidance was published. People having treatment outside these recommendations 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 extensive-stage small-cell lung cancer have carboplatin and etoposide chemotherapy as their first treatment. Clinical trial evidence is in people with an ECOG status of 0 or 1 (that is, they are more able to do daily tasks and ordinary activities than those with poorer ECOG 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.
Atezolizumab meets NICE's criteria to be considered a life-extending treatment at the end of life. The cost-effectiveness estimates comparing atezolizumab and chemotherapy with chemotherapy alone are uncertain, but they are within what NICE normally considers an acceptable use of NHS resources. Because the clinical evidence is for people with an ECOG status of 0 or 1, atezolizumab with carboplatin and etoposide is only recommended for this group.