The draft guidance means pembrolizumab (Keytruda, Merck Sharp & Dohme) with pemetrexed and platinum chemotherapy will be available as a first-line treatment option for adults whose tumours have no epidermal growth factor receptor (EGFR)-positive or anaplastic lymphoma kinase (ALK)-positive mutations.
The combination treatment was previously available to people through the Cancer Drugs Fund and has now been approved for routine commissioning on the NHS. Around 3,000 people will be eligible for this treatment in England.
Previously, standard care for tumours that have no EGFR-positive or ALK-positive mutations depended on PD-L1 status. The new draft guidance means people with advanced non-squamous NSCLC will now be eligible for pembrolizumab with pemetrexed and platinum chemotherapy for up to two years, regardless of their PD-L1 status.
Clinical trial evidence suggests that patients live longer when treated with the pembrolizumab combination treatment compared with standard chemotherapy. However, there was no change in overall survival in patients with a PD-L1 positive tumour with a score of 50% or more when compared to those treated with pembrolizumab monotherapy, which is standard care for this patient group.
Meindert Boysen, director of the NICE Centre for Health Technology Evaluation, said: “Through the Cancer Drugs Fund, pembrolizumab with pemetrexed and platinum chemotherapy has shown the potential to extend the lives of thousands of individuals, and we are pleased to now be able to recommend the treatment routinely.”
With the new draft guidance, patients meeting the specifications will now be eligible to receive pembrolizumab with pemetrexed and platinum chemotherapy for two years, or until their disease progresses within this period.
Professor Peter Johnson, NHS clinical director for cancer said: “As well as helping 200,000 people begin cancer care since the start of the pandemic and delivering more than 389,000 cancer treatments throughout the coronavirus pandemic, the NHS has been working to bring in new treatments that offer the best care. This is the latest deal that the NHS has struck to help hundreds of patients every year, who will now be able to have this immunotherapy as an option for their lung cancer.”
NICE expects to publish final guidance on the recommendation in March 2021. You can read the draft guidance here.
Update: The final guidance has been published and can now be accessed here.