1.1 Atezolizumab is recommended as an option for treating locally advanced or metastatic non-small-cell lung cancer (NSCLC) in adults who have had chemotherapy (and targeted treatment if they have an EGFR- or ALK‑positive tumour), only if:
atezolizumab is stopped at 2 years of uninterrupted treatment or earlier if the disease progresses and
the company provides atezolizumab with the discount agreed in the patient access scheme.
1.2 This recommendation is not intended to affect treatment with atezolizumab 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
Treatments for NSCLC after chemotherapy include docetaxel alone, pembrolizumab (for tumours expressing the PD‑L1 protein) and nintedanib plus docetaxel for adenocarcinoma.
Clinical trial evidence shows that people having atezolizumab live longer than those having docetaxel alone. There is no evidence directly comparing atezolizumab with pembrolizumab. But indirect analyses show that for people with PD‑L1‑positive disease, there may be no difference in survival benefit for atezolizumab compared with pembrolizumab.
Atezolizumab meets NICE's criteria to be considered a life-extending treatment at the end of life compared with docetaxel alone, but not compared with pembrolizumab.
The most plausible cost-effectiveness estimates for atezolizumab, compared with docetaxel (for PD‑L1‑negative disease) and with pembrolizumab (for PD‑L1‑positive disease), are within the range NICE considers an acceptable use of NHS resources. Therefore it can be recommended after chemotherapy for locally advanced or metastatic NSCLC.