The National Institute for Health and Care Excellence (NICE) has recommended that relapsed (second line) non-small cell lung cancer (NSCLC) patients no longer have access to cancer pill Tarceva® (erlotinib) because it does not meet their criteria for clinical and cost-effectiveness.(1)
The decision will set lung cancer care in England and Wales backwards and over 1,000 patients a year will be left without an active treatment option after their first-line therapy has failed while patients in Scotland and the rest of Europe continue to benefit from erlotinib.(2)
Clinicians use erlotinib to treat six out of 10 patients receiving active anticancer therapy for relapsed NSCLC(4) but after re-reviewing its existing guidance, NICE will leave patients with access to only the chemotherapy, docetaxel, which many patients are too sick to tolerate.(5) This will effectively leave these less fit patients with no active treatment option to fight their cancer and goes against NHS England’s policy which states that no patient will be without access to cancer treatment.(6)
Dr Mick Peake, Consultant Physician at the University Hospitals of Leicester NHS Trust and Clinical Lead, National Cancer Intelligence Network, (NCIN) said: “Lung cancer is one of the most difficult cancers to treat and the decision to remove what has become a standard of care will make our job as clinicians more difficult, particularly impacting on some of our sickest patients. Experienced clinicians need more freedom to be able to choose the treatment that they think is right for each patient.”
It seems perverse that this NICE guidance will limit the treatment options available to only docetaxel, given that the independent evidence review shows the total NHS treatment costs of docetaxel to be higher than those of erlotinib.(1) This difference arises because docetaxel needs to be given intravenously in hospital, whereas erlotinib is an oral treatment taken at home.(1) The cost of managing treatment side effects is also greater with docetaxel, especially for life-threatening febrile neutropenia* which normally requires hospitalisation for antibiotic therapy.(5,7)
International benchmarking studies show that the UK lags behind many other European countries in terms of lung cancer survival rates due to late diagnosis and poor treatment access, amongst other factors.(8,9) Lung cancer treatment rates in the UK are already low with less than 40% of patients receiving any kind of active treatment when their cancer relapses.(2) The NICE decision would reduce this even further and impact treatment now and in the future, as a significant number of new lung cancer medicines currently in development are designed to be combined with erlotinib.(10)
Clinicians, patients and the public have until 24 February to respond to the preliminary NICE decision. NICE will then publish its final decision in June.
Lung cancer by numbers:
- 35,184 people died of lung cancer in the UK in 2011 alone – this is equivalent to one death every 15 minutes(3)
- Over 1,000 patients will be affected by NICE’s proposed decision(2)
- Less than 30% of UK lung cancer patients will be alive one year after diagnosis(9)
- In the UK, fewer than 9% of lung cancer patients will be alive five years after diagnosis(9)
The most common side effects of erlotinib are rash and diarrhoea, both of which are usually manageable.(11)
*When a patient experiences a drop in the number of types of white blood cells needed to fight infections associated with fever and, often, other signs of infection
References
- National Institute of Health and Care Excellence (NICE). Appraisal Consultation Document (ACD), TA162. January 2014
- Roche Data on File
- Cancer Research UK. Lung cancer – UK mortality statistics. Available at: http://info.cancerresearchuk.org/cancerstats/types/lung/mortality/uk-lung-cancer-mortality-statistics (last accessed January 2014)
- Roche Data on File
- Liverpool Reviews and Implementation Group (LRiG). Erlotinib and gefitinib for treating non-small cell lung cancer that has progressed following prior chemotherapy (review of NICE technology appraisals 162 and 175). October 2013. Available at: http://www.nice.org.uk/nicemedia/live/14090/65682/65682.pdf (last accessed January 2014)
- Daily Mail. Emergency cancer drug fund ‘runs out of cash’: Thousands face being denied life-extending medication. November 2013. Available here: http://www.dailymail.co.uk/health/article-2514743/Emergency-cancer-drug-fund-cash-Thousands-face-denied-medication.html (last accessed January 2014)
- Lymphoma Association. Neutropenia – a guide for people with lymphoma, April 2013. Available at: https://www.lymphomas.org.uk/sites/default/files/pdfs/Neutropenia-a-guide-for-people-with-lymphoma.pdf (last accessed January 2014)
- De Angelis R et al. Cancer survival in Europe 1999—2007 by country and age: results of EUROCARE-5—a population-based study. Lancet Oncology 2014; 15, 1: 23–34
- Coleman MP et al. Cancer survival in Australia, Canada, Denmark, Norway, Sweden, and the UK, 1995–2007 (the International Cancer Benchmarking Partnership): an analysis of population-based cancer registry data. The Lancet 2011; 377: 127-138
- ClinicalTrial.gov. 123 studies found for: erlotinib, open studies, lung cancer. Available at: http://clinicaltrials.gov/ct2/results?term=erlotinib&recr=Open&rslt=&type=&cond=lung+cancer&intr=&titles=&outc=&spons=&lead=&id=&state1=&cntry1=&state2=&cntry2=&state3=&cntry3=&locn=&gndr=&rcv_s=&rcv_e=&lup_s=&lup_e= (last accessed January 2013)
- Electronic Medicines Compendium. Tarceva Film-Coated Tablets: Summary of Product Characteristics. Available at http://www.medicines.org.uk/emc/medicine/16781/spc (last accessed January 2014)
