Thousands of lung cancer patients to get NHS access to Keytruda

Keytruda (pembrolizumab) with pemetrexed and platinum chemotherapy is recommended as an option for adults with untreated non-small-cell lung cancer, whose tumours have no epidermal growth factor receptor (EGFR)- or anaplastic lymphoma kinase (ALK)-positive mutations.

According to NICE, more than 3,000 patients in England may be eligible for treatment with the immunotherapy combination, which in a clinical trial was shown to extend progression-free survival by nearly four months compared to pemetrexed with platinum chemotherapy alone.

The Institute concluded further evidence is needed on the benefits of the combination therapy, but felt it has the potential to be cost effective and was likely to extend life, making it eligible for use on the Cancer Drugs Fund.

Under a CDF managed access agreement, MSD will continue to collect data on the treatment’s effectiveness until June 2019, after which a further review of these guidelines will take place.

NICE has recommended that the treatment is given for a maximum of two years, "because it is thought that patients do not need to continue treatment beyond this point to achieve the benefits," explained Meindert Boysen, director of the NICE Centre for Health Technology Evaluation. However, this will be reconsidered after new evidence has been collected.

"This decision is good news for people affected by this type of lung cancer. This drug combination has shown significant benefits for some patients in clinical trials, helping them to survive their cancer for longer," noted Professor Charles Swanton, Cancer Research UK’s chief clinician.

"This also shows the value of the Cancer Drugs Fund, which gives NICE the option to approve promising treatments while more data is collected on their long-term benefits. Lung cancer is the biggest cancer killer in the UK so it’s vital that innovations like this reach patients as quickly as possible."

"This could be one of the biggest advances in the treatment of non-small cell lung cancer in recent years" said Toby Talbot, consultant clinical ncologist, Royal Cornwall Hospital, NHS, and KEYNOTE-189 investigator.

"The results are particularly impressive for patients with low PDL1 expression – these patients have not been able to access the benefits of immunotherapy without having conventional chemotherapy first. The availability of combination therapy is a huge leap forward in improving the prognosis of patients with non-squamous non-small cell lung cancer."

John Stewart, NHS England’s director of specialised commissioning, also noted that NHS England "worked closely with MSD to reach a commercial deal to make this innovative drug available to a new group of lung cancer patients," and that "this is another example of how a more flexible approach to price negotiation has clear benefits – not only for patients, but also for industry and taxpayers."