NICE shuts down AZ's Tagrisso—and backs Pfizer rival Vizimpro instead

England’s cost watchdogs won’t get behind AstraZeneca blockbuster Tagrisso in previously untreated patients with EGFR-mutated lung cancer. But in a change of events, they’re instead backing a Pfizer challenger.

Friday, the National Institute for Health and Care Excellence (NICE) deemed Tagrisso too expensive for routine NHS use, dealing a blow to AZ’s sales ambitions. NICE already endorses Boehringer Ingelheim’s Gilotrif, Roche’s Tarceva and AstraZeneca’s own Iressa, it said (PDF), and while Tagrisso has topped both Tarceva and Iressa in trials, there’s no evidence that it can beat out Gilotrif.

While the body sometimes covers a drug under its Cancer Drugs Fund while companies collect more data, NICE shut down that option for the British drugmaker. "It does not have the potential to be cost effective at the price offered," it said. Tagrisso runs at £5,770 for a pack of 30 tablets, and the confidential discount AZ served up wasn’t enough to sway the gatekeeper.

Meanwhile, though, Pfizer can’t say the same. After an initial rejection, NICE came around to support its Vizimpro on Friday, and it made clear that Pfizer’s price break on the drug was responsible for the about-face.

Vizimpro, new on the scene after picking up its European green light for first-line patients in early April, has only topped Iressa in the clinic, and "an indirect comparison suggests there is no difference between" it and Gilotrif "in terms of how long people live or how long it is before their disease gets worse," NICE said (PDF) in final draft guidance.

Still, though, "the most plausible cost-effectiveness estimate is within what NICE normally considers an acceptable use of NHS resources," it wrote.

Pfizer, for its part, was pleased with the decision. "We welcome NICE’s decision," Olivia Ashman, oncology medical director at Pfizer UK, said in a statement, adding that "lung cancer remains a challenging condition to treat and we are pleased that clinicians managing patients with EGFR-mutated NSCLC will now have access to this important medicine."

AstraZeneca, though, likely isn’t too happy with the latest developments—and it wouldn’t be the first time it ran into frustrations with NICE. Back in 2016, it faced a NICE delay on Tagrisso in previously treated patients, and then-U.K. head Lisa Anson said the company was "very disappointed."

"It takes longer for NICE to agree on the same data set that other markets have had and granted access to," she griped in an interview with The Telegraph.