The National Institute for Health and Care Excellence has updated its recommendations on the treatment of non-small cell lung cancer that has progressed after chemotherapy.

In a change from existing guidance, NICE is planning on barring access to AstraZeneca’s Iressa (gefitinib), but is still endorsing the use of Roche’s Tarceva (erlotinib) in certain circumstances, to reflect the most up-to-date evidence.

Clinical practice has changed since the original guidance on these drugs was published, it said, noting that NSCLC patients now have their tumour tested for EGFR-TK mutation status at diagnosis before receiving first-line therapy to ensure that the most appropriate treatment is selected. 

NICE has already recommended Tarceva and Iressa, both EGFR-TK inhibitors, as first-line treatments when tumours carry this mutation. But clinical specialists told the independent advisory committee that, in clinical practice, when patients have received these drugs as first-line treatment, it is unlikely that they benefit from second-line treatment with an EGFR-TK inhibitor because of reduced sensitivity to them. 

Delayed diagnosis

Also, the committee heard that a small group of patients may receive a delayed diagnosis of mutation status, and while for some it is OK to wait for two weeks for confirmation and treatment, patients with aggressive disease need immediate treatment before EGFR-TK mutation status is confirmed. 

Therefore, in the new draft guidance, Tarceva is provisionally recommended as an option for treating disease that has progressed in people who have had non-targeted chemotherapy, but only when confirmation of their tumour status is delayed. 

The Institute has also stipulated that the person’s disease responds to the first two cycles of treatment with Tarceva and that Roche provides the drug with the discount agreed in the patient access scheme. 

“The ongoing review of these two treatments incorporates new evidence on the clinical and cost effectiveness of erlotinib and gefitinib – the revised recommendations aim to ensure that patients are offered the most appropriate treatments,” said Andrew Dillon, NICE’s chief executive.