The National Institute for Health and Care Excellence (NICE) has turned down Eli Lilly's Alimta (pemetrexed) for the maintenance treatment of lung cancer, on grounds that drug failed to provide enough of a benefit to justify its cost in this patient group.

The cost watchdog has now published final draft guidance that does not recommend Alimta for the maintenance treatment of locally-advanced or metastatic non-squamous non-small-cell lung cancer (NSCLC) in patients whose disease has not progressed immediately following induction therapy with pemetrexed and cisplatin.

While conceding that the drug indeed showed some benefit to patients, the expert review group calculated its incremental cost to be £74,500 per QALY gained, and thus far above what is normally considered a cost-effective use of NHS resources.

"It is disappointing not to be able to recommend pemetrexed in this final draft guidance, but we can only recommend treatments which are both clinically and cost effective," said NICE chief executive Andrew Dillon.

NICE already recommends pemetrexed in combination with cisplatin as a first-line treatment option for certain types of locally-advanced or metastatic NSCLC and as a maintenance treatment option for locally-advanced or metastatic non-squamous NSCLC, if the disease has not progressed immediately following platinum-based chemotherapy in combination with gemcitabine, paclitaxel or docetaxel. 

Pixuvri cleared

Meanwhile, some patients with an aggressive type of non-Hodgkin's lymphoma will have a new treatment option funded by the NHS after NICE endorsed Cell Therapeutics' Pixuvri (pixantrone).

The drug has been recommended for use as a monotherapy for patients with aggressive non-Hodgkin's B-cell lymphoma whose disease has either returned after treatment (relapsed) or become resistant to current therapy (refractory) and: have previously been treated with the drug rituximab (MabThera); are receiving third or fourth line treatment; and if the manufacturer provides Pixuvri at a discounted rate as agreed with the Department of Health.

"Most people currently receive chemotherapy and the drug rituximab so pixantrone will provide a valuable extra treatment option when the disease has relapsed or become resistant," commented Professor Carole Longson, NICE's Health Technology Evaluation Centre Director.