1 Recommendations

Guidance

1.1 Atezolizumab is recommended as an option for treating locally advanced or metastatic urothelial carcinoma in adults who have had platinum-containing chemotherapy, 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

These recommendations only cover people with locally advanced or metastatic urothelial carcinoma who have had platinum-containing chemotherapy. There is separate guidance on atezolizumab for untreated disease for people who cannot have cisplatin.

Treatment options for people whose disease has progressed after platinum-containing chemotherapy include docetaxel, paclitaxel or best supportive care.

Evidence from 2 clinical trials, one of which compares atezolizumab directly with chemotherapy, suggests that atezolizumab is an effective treatment. According to clinical experts, the trial results compare favourably with their experience of current treatments for the disease.

Atezolizumab meets NICE's criteria to be considered a life-extending treatment at the end of life.

Although there are uncertainties in the economic model, the most plausible cost-effectiveness estimates for atezolizumab compared with taxanes are within the range NICE considers an acceptable use of NHS resources. Therefore, atezolizumab can be recommended as an option for treating locally advanced or metastatic urothelial carcinoma in adults who have had platinum-containing chemotherapy.