It is looking unlikely that lung cancer patients in England and Wales will get access to Eli Lilly's new treatment Portrazza on the National Health Service, after the drug received an initial rejection from cost regulators.

The National Institute for Health and Care Excellence has published draft guidelines rejecting the drug, in combination with gemcitabine and cisplatin, for treating locally advanced or metastatic epidermal growth factor receptor (EGFR)- expressing squamous non-small-cell lung cancer that has not been treated with chemotherapy.

The Institute's independent appraisal committee acknowledged that Portrazza (necitumumab) provides small improvements in overall survival, but considered its cost too high compared to combination chemotherapy.

It concluded that the most plausible incremental cost-effectiveness ratio (ICER) for the drug compared with gemcitabine plus cisplatin was £110,000-£170,000 per quality-adjusted life year (QALY) gained, and was likely to be towards the upper end of this range, and thus far outside the realm of what is normally considered value for money.

The committee also concluded that the drug did not meet the criteria to be considered for use in the Cancer Drugs Fund as it was not cost-effective and no clinical uncertainties could be addressed from further data collection.

Portrazza was approved by European regulators back in February as the first biologic option for this subset of lung cancer patients, offering a new approach where there has been little progress in twenty years.

Clearance came after the Phase III SQUIRE trial showed that the addition of Portrazza to gemcitabine and cisplatin chemotherapy improves overall survival in patients, with median survival of 11.5 months versus 9.9 months.