1.1 Atezolizumab is recommended, within its marketing authorisation, as an option for untreated locally advanced or metastatic urothelial cancer in adults whose tumours express PD‑L1 at a level of 5% or more and when cisplatin-containing chemotherapy is unsuitable. This is only if the company provides atezolizumab according to the commercial arrangement.
Why the committee made these recommendations
This appraisal reviews the additional evidence collected as part of the Cancer Drugs Fund managed access agreement for atezolizumab for untreated PD‑L1‑positive locally advanced or metastatic urothelial cancer when cisplatin is unsuitable.
The new evidence includes data from a clinical trial and from people having treatment in the NHS, while this treatment was available in the Cancer Drugs Fund in England. The clinical trial shows that people who have atezolizumab are likely to live longer than those who have platinum-based chemotherapy.
Atezolizumab meets NICE's criteria to be considered a life-extending treatment at the end of life. The cost-effectiveness estimates are likely to be within what NICE considers an acceptable use of NHS resources. So, atezolizumab is recommended.