2 The technology
2.1 Nintedanib (Vargatef, Boehringer Ingelheim) is a small molecule tyrosine‑kinase inhibitor. It blocks 3 receptor classes that promote angiogenesis and tumour growth: vascular endothelial growth factor receptors; fibroblast growth factor receptors; and platelet‑derived growth factor receptors α and β. Nintedanib has a UK marketing authorisation for use 'in combination with docetaxel for the treatment of adult patients with locally advanced, metastatic or locally recurrent non‑small‑cell lung cancer (NSCLC) of adenocarcinoma tumour histology after first‑line chemotherapy'.
2.2 The summary of product characteristics lists the following adverse reactions for nintedanib as being the most frequently reported: diarrhoea, increased plasma liver enzyme concentrations (alanine transaminase and aspartate aminotransferase) and vomiting. For full details of adverse reactions and contraindications, see the summary of product characteristics.
2.3 The recommended dose is 200 mg twice daily. This can be reduced to 150 mg or 100 mg twice daily in patients who experience adverse events. Nintedanib costs £2151.10 for a 30‑day pack of 150 mg or 100 mg capsules for oral use (excluding VAT, MIMS online accessed March 2015). The company has agreed a patient access scheme with the Department of Health. This scheme provides a simple discount to the list price of nintedanib, with the discount applied at the point of purchase or invoice. The level of the discount is commercial in confidence. The Department of Health considered that this patient access scheme does not constitute an excessive administrative burden on the NHS.