Clinical update

Combination therapy for untreated, metastatic, non-squamous non-small-cell lung cancer

NICE recommends use of pembrolizumab with pemetrexed and platinum chemotherapy

NICE recommends use of combination treatment pembrolizumab with pemetrexed and platinum chemotherapy in England


Picture: Alamy

Essential facts

More than a decade after UK countries banned smoking in public spaces and enclosed workplaces, lung cancer remains commonplace.

Cancer Research UK says there are about 46,700 new cases of the disease in the UK every year, or almost 130 every day. Most are diagnosed when the patient presents as an emergency.

In 2016, lung cancer caused more than 35,600 deaths in the UK. Figures for England and Wales show that only 5% of patients survive lung cancer for ten or more years.

Almost 80% of lung cancers are said to be preventable and 72% are caused by smoking. Strong evidence suggests a healthy diet and regular exercise reduce risk, as well as giving up smoking.

The most common disease type is non-small-cell lung cancer, which accounts for 80% of cases. Small-cell lung cancer is less common but usually more aggressive.

Signs and symptoms

Common symptoms of lung cancer include a cough for three weeks or more, a change in a longstanding cough, breathlessness and a chest infection that fails to improve or that recurs.

However, a 2015 report by the British Lung Foundation on emergency presentation of lung cancer said some patients reported none of the common symptoms. Others had been diagnosed with pneumonia by their GP or said their recurring chest infections had not been followed up. 

The report said greater awareness of signs and symptoms among patients and health professionals would aid diagnosis.

What’s new

The National Institute for Health and Care Excellence (NICE) announced in November that a new life-extending treatment should be made available in England through the Cancer Drugs Fund.

The treatment, pembrolizumab with pemetrexed and platinum chemotherapy, is recommended as an option for untreated, metastatic, non-squamous non-small-cell lung cancer.

Clinical trials suggest this combination therapy can give patients almost four additional months without their cancer progressing, compared with standard treatment of pemetrexed with platinum chemotherapy.

NICE says more than 3,000 patients in England may be eligible for the new combined treatment.

What others say

Cancer Research UK described the NICE decision as good news for patients. Chief clinician Charles Swanton said: ‘This shows the value of the Cancer Drugs Fund, which gives NICE the option to approve promising treatments while more data is collected on their long-term benefits.’

Expert comment

Josie Roberts is a Macmillan lung nurse specialist at Rotherham NHS Foundation Trust

Lung cancer is the biggest cancer killer in the UK and the most common cancer worldwide. But treatments have improved, particularly for those patients diagnosed at stages I and II.

The implementation of the National Optimal Lung Cancer Pathway aims to enhance this by driving further improvements in standards of care and outcomes for patients in England.

And in October 2016, the UK Lung Cancer Coalition published the report 25 by 25: A Ten-Year Strategy for Improving Lung Cancer Survival Rates, which aimed to raise the five-year survival rate to 25% by 2025.

NICE’s support for treatments that enables people to be given anti-cancer therapy with the aim of increasing survival rates is essential in improving the quality of life of those living with lung cancer.



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