1.1 Durvalumab monotherapy is recommended for use within the Cancer Drugs Fund as an option for treating locally advanced unresectable non-small-cell lung cancer (NSCLC) in adults whose tumours express PD‑L1 on at least 1% of tumour cells and whose disease has not progressed after platinum-based chemoradiation only if:
they have had concurrent platinum-based chemoradiation
the conditions in the managed access agreement are followed.
1.2 This recommendation is not intended to affect treatment with durvalumab 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
Locally advanced NSCLC that is unresectable is usually treated with platinum-based chemoradiation. After this there are no treatment options to delay or stop the disease progressing. Durvalumab is a possible treatment at this stage.
The main evidence for durvalumab comes from a clinical trial (PACIFIC). This suggests that durvalumab is more effective than standard care in delaying disease progression after concurrent platinum-based chemoradiation (chemotherapy and radiation at the same time). But PACIFIC is ongoing, so there is not yet enough evidence about:
how long the treatment effect of durvalumab lasts
how many people taking durvalumab would live without their disease progressing.
Durvalumab has the potential to be cost effective compared with standard care, but more evidence from the ongoing trial is needed to address the uncertainties. Therefore, it is recommended for use in the Cancer Drugs Fund.