The National Institute for Health and Care Excellence (NICE) has recommended the use of Alunbrig (brigatinib) for treating ALK-positive advanced non-small-cell lung cancer after Xalkori (crizotinib) on the NHS in England and Wales.

The decision comes after an earlier appraisal consultation document (ACD) said the Takeda drug was not cost-effective in this setting.

An improved commercial agreement from the company and further clarifications about its economic model mean it is now recommended for routine use in the NHS.

The committee also took into account that future treatments will be limited for this population because Xalkori is no longer considered first-line treatment for ALK-positive NSCLC.

People with this form of lung cancer are currently offered Zykadia (ceritinib) as a second line treatment. People taking Zykadia survive for 18 months on average, based on evidence from the ASCEND-5 trial. Results from the ALTA trial showed that people taking Alunbrig whose disease had progressed on Xalkori could live an average of 34 months.

Alunbrig is also less toxic than Zykadia, the final appraisal document (FAD) says.

The drug is taken as a daily tablet, with a proposed list price of £4,900 for 28x180mg tablets, but under its commercial agreement manufacturer Takeda will provide it to the NHS at a confidential discounted price.

Fewer than 50 people in England will be eligible, and that number will reduce further because Xalkori is no longer considered the first-line treatment.