1.1 Brigatinib is recommended, within its marketing authorisation, as an option for treating anaplastic lymphoma kinase (ALK)-positive advanced non-small-cell lung cancer (NSCLC) that has not been previously treated with an ALK inhibitor in adults. It is recommended only if the company provides brigatinib according to the commercial arrangement.
Why the committee made these recommendations
People with ALK-positive advanced NSCLC who have not had an ALK inhibitor before are usually offered alectinib. If a person's ALK status is not known at diagnosis, crizotinib is offered after chemotherapy. Brigatinib may be offered as an alternative to these treatments.
Clinical evidence shows that brigatinib is more effective than crizotinib at delaying disease progression. It suggests that brigatinib extends life more than crizotinib, but this is uncertain. There is no clinical trial evidence directly comparing brigatinib with alectinib. An indirect comparison suggests that brigatinib is as effective as alectinib in delaying disease progression, including in the central nervous system. However, although it appears that brigatinib could extend life as much as alectinib, there is uncertainty because of a lack of long-term data.
Despite the uncertainty, the most likely cost-effectiveness estimates for brigatinib are within what NICE considers an acceptable use of NHS resources. So, brigatinib is recommended.