Cemiplimab with platinum-based chemotherapy should not be used for untreated non-small-cell lung cancer (NSCLC) in adults when the cancer:
is locally advanced and not suitable for definitive chemoradiation, or metastatic
has PD‑L1 in 1% or more of the tumour cells, and
has no EGFR, ALK or ROS‑1 aberrations.
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 is not required to be funded and should not be used routinely in the NHS in England for the condition and population in the recommendations.
This is because the available evidence does not suggest that cemiplimab with platinum-based chemotherapy is value for money.
Usual treatment for advanced NSCLC includes chemotherapy alone, immunotherapy alone, or immunotherapy plus chemotherapy. Cemiplimab is a type 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 does not include everyone who it 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.
There are concerns with the economic model. This is mainly because of the way the company structured its model.
Because of the uncertainties in the economic model, it is not possible to determine the most likely cost-effectiveness estimates for cemiplimab plus chemotherapy. Also, the cost-effectiveness estimates preferred by the company and the external assessment group are above the range normally considered an acceptable use of NHS resources. So, it should not be used.