Roche's Tecentriq-Avastin lung cancer combo gets a lift from England's cost watchdogs

Roche has some hard-earned knowledge about working with England’s cost watchdogs, especially where its cancer drugs are concerned. And it put that know-how to use to score backing for Tecentriq in lung cancer.

The National Institute of Health and Care Excellence (NICE) decided to back the immuno-oncology drug, in combination with Roche’s Avastin and chemo, in previously untreated non-small cell lung cancer (NSCLC), the Swiss drugmaker said Thursday.

The nod covers non-squamous NSCLC patients whose tumors express low levels of PD-L1 or don’t express the biomarker at all. And it applies to those with EGFR- or ALK-positive tumors who've have failed on targeted therapy.

But NICE had some conditions when it agreed to foot the bill for Tecentriq. For one, patients must stop the combo after two years of uninterrupted treatment—or earlier, if their disease progresses. And they’ll only get the cocktail if Roche sticks to a confidential price break it served up in negotiations with the gatekeeper.

"There is uncertainty about the company’s long-term survival estimates, especially for people with EGFR- or ALK-positive NSCLC. But including the most plausible assumptions and the commercial arrangements, the cost-effectiveness estimates are within what NICE normally considers acceptable for an end-of-life treatment," NICE said in final guidance.

Even with the restrictions, the NICE decision opens up treatment for 4,800 patients in England, according to Roche’s estimates. And that’s good news for Roche, which is jockeying for position in the first-line lung cancer field against Merck & Co., whose Keytruda had broader approval in the setting—along with a head start—when Tecentriq launched.

Meanwhile, Roche, which has a contentious history with NICE, can add to its list of Tecentriq indications the agency endorses. Last April, NICE changed its mind and issued a positive decision on Tecentriq as a treatment for previously treated lung cancer.

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