Atezolizumab is recommended, within its marketing authorisation, as an option for untreated metastatic non-small-cell lung cancer (NSCLC) in adults if:
their tumours have PD-L1 expression on at least 50% of tumour cells or 10% of tumour-infiltrating immune cells
their tumours do not have epidermal growth factor receptor (EGFR) or anaplastic lymphoma kinase (ALK) mutations and
the company provides atezolizumab according to the commercial arrangement.
Standard care for untreated metastatic NSCLC tumours with no EGFR or ALK mutations depends on PD-L1 status. If tumours are PD-L1 positive with a score of at least 50%, pembrolizumab monotherapy is offered as standard. Pembrolizumab in combination with chemotherapy may also be offered.
Results from an indirect comparison suggest that atezolizumab is as effective as pembrolizumab in delaying disease progression and in extending life. However, this is uncertain because there is no direct evidence comparing them. Despite the uncertainty in the indirect comparison, the most likely cost-effectiveness estimates for atezolizumab are within what NICE considers an acceptable use of NHS resources. So atezolizumab is recommended.