1.1 Alectinib is recommended, within its marketing authorisation, as an option for untreated anaplastic lymphoma kinase (ALK)-positive advanced non-small-cell lung cancer (NSCLC) in adults. It is recommended only if the company provides alectinib according to the commercial arrangement.
Why the committee made this recommendation
People with untreated ALK-positive advanced NSCLC are usually offered crizotinib.
The main evidence for alectinib comes from an ongoing clinical trial. This suggests that alectinib is more effective than crizotinib in delaying disease progression, including in the central nervous system. There is not enough evidence to tell how long alectinib prolongs life compared with crizotinib.
There is uncertainty about how treatments after disease progression affect people's quality and length of life. But using the most plausible assumptions and with the commercial arrangement, the cost-effectiveness estimates for alectinib compared with crizotinib are within the range NICE normally considers acceptable. Therefore, alectinib is recommended for untreated advanced ALK-positive NSCLC.