Atezolizumab has failed to secure NICE approval for use with carboplatin and etoposide in adults with untreated extensive-stage small-cell lung cancer (ES-SCLC).
The draft decision is based on clinical evidence from the randomised placebo-controlled IMpower133 trial which compared atezolizumab plus carboplatin and etoposide with placebo plus carboplatin and etoposide in adults with untreated ES-SCLC with an ECOG performance status of 0 or 1.
At the April 2018 cut-off, the trial reported a median progression-free survival (PFS) of 5.2 months with atezolizumab combination therapy and 4.3 months with standard chemotherapy (HR 0.77; 95% CI 0.62-0.96).
At a cut-off date of January 2019, median overall survival (OS) was 12.3 months and 10.3 months, respectively (HR 0.76; 95% CI 0.60-0.95). However, the NICE appraisal committee noted that the atezolizumab and placebo arms had almost come together by about 30 months, which may suggest that there is little OS benefit with atezolizumab after this point.
The committee concluded that while the trial data showed that atezolizumab combination therapy improves OS and PFS, the long-term OS benefit remains uncertain.
It also highlighted that IMpower133 only included people with an ECOG performance status of 0 or 1, while NHS England patient are likely to have an ECOG status of ≥2.
The draft decision is open for public consultation. The closing date for comments is 28 January 2020.