New lung cancer treatment combo approved on NHS in England

Cancer

Non small cell lung cancer cells.

A new treatment for some people with a type of non small cell lung cancer (NSCLC) will now be routinely available on the NHS in England, following its approval by the National Institute of Health and Care Excellence (NICE).

The decision means the immunotherapy drug pembrolizumab (Keytruda), in combination with the chemotherapy drugs carboplatin and paclitaxel, will continue to be an option for adults with untreated, squamous non small cell lung cancer that’s spread to other parts of the body.

The combination was previously available to people in England through the Cancer Drugs Fund, which gives people access to innovative treatment while more data is collected on their long-term benefits.

“From supporting patients throughout their lung cancer journey, we understand how devastating a lung cancer diagnosis is,” said Lorraine Dallas, Director of Prevention Information and Support at Roy Castle Lung Cancer Foundation. “That is why we welcome this treatment option.

Having ways to manage their cancer and maintain their quality of life in the face of uncertainty is valuable.”

The decision follows the approval last year of pembrolizumab alongside a different combination of chemotherapy drugs, pemetrexed and cisplatin, to treat those with a different type of non small cell lung cancer.

Increasing survival

This treatment combination was made available through the Cancer Drugs Fund after initial trial data indicated that adding pembrolizumab increased survival for people with untreated, squamous non small cell lung cancer that’s spread to other parts of the body.

Further analysis has showed that people received pembrolizumab lived on average for 17.1 months, compared to 11.6 months for those who only received chemotherapy. Those who received pembrolizumab in their treatment also experienced more time without their cancer progressing.

“The combination of immunotherapy and chemotherapy used in this trial, which has now been commissioned for routine use on the NHS in England, is a major breakthrough for this subtype of lung cancer, which until now has had few treatment options, poor prognosis and relatively little positive research compared to other forms of lung cancer,” said Dr Toby Talbot, consultant oncologist at Royal Cornwall Hospital.

Making the treatment available to more people

Pembrolizumab is an immunotherapy that aims to boost the immune system’s ability to recognise and kill cancer cells. It works by blocking a molecule found on immune cells – called PD-1 – from talking to cancer cells by attaching to a protein known as PD-L1.

In 2020, the drug was approved for use in England for some cancers, but this depended on whether or not tumours tested positive for PD-L1.

Last year, the drug was then approved to treat a type of non small cell lung cancer called non-squamous non small cell lung cancer in combination with the chemotherapy drugs pemetrexed and cisplatin, whether the tumour tested positive for PD-L1 or not.

Now, the drug is approved for a new subset of lung cancer patients – those with squamous non small cell lung cancer, in combination with carboplatin and paclitaxel, meaning even more people can benefit from this immunotherapy drug.

Types of lung cancer

There are several different types of lung cancer, usually defined by the kind of cell the cancer starts in. Knowing the kind of lung cancer someone has can determine what kind of treatment they should receive.

The 2 main groups of lung cancer are non small cell lung cancer (the most common type) and small cell lung cancer.

These groups can be split into even more groups depending on how and where the cancer forms, such as squamous non small cell lung cancer, which develops from the flat cells that cover the surface of your airways, and non-squamous non small cell lung cancer, which develops from other cells in the lungs such as glands that make mucus.

Learn more about the different types of lung cancer

NICE decisions are usually adopted in Wales and Northern Ireland as well, so the decision is likely to affect patients in all 3 nations. Scotland has a separate process for reviewing drugs.

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