Clinical update

Durvalumab: NICE recommends new lung cancer treatment

New drug is 'biggest advance' seen for some time in treating certain lung cancers

New immunotherapy treatment 'biggest advance' seen for some time in treating certain lung cancers 

Picture: Juan Gaertner/Science Photo Library

Essential facts

A new lung cancer immunotherapy treatment should be made available to some lung cancer patients in England, according to the National Institute for Health and Care Excellence (NICE).

NICE says durvalumab (Imfinzi) should be given to people with locally advanced unresectable non-small-cell lung cancer who have had platinum-based chemoradiation.

Durvalumab is a PD-L1 inhibitor – it helps the body’s immune system to find and attack cancer cells by blocking the PD-L1 protein that disguises cancer.

What's new?

As part of a clinical trial, people taking the drug went for an average of two years without the disease progressing, compared to around six months for those who did not get it.

NICE believes between 27% and 40% of people taking durvalumab would have five years of progression-free survival.

Regulatory approval has been granted for patients whose tumours express PD-L1 on at least 1% of tumour cells and whose disease has not progressed after concurrent platinum-based chemoradiation.

It was not given to patients who have had sequential chemoradiation, which tends to be the most common form of treatment for these patients, because of a lack of evidence.

What others say

Royal Marsden consultant clinical oncologist Fiona McDonald, who advised NICE on the drug, said it is possibly the ‘biggest advance’ seen for some time in treating this form of lung cancer, which accounts for about one fifth of all lung cancers.

‘For our patients, it’s fantastic news; I expect to see an immediate impact on clinical practice, and for this treatment to become the standard of care for eligible patients.’

Some experts told NICE it may be ‘potentially curative’.

But NICE said further evidence needed to be gathered to prove this and said it was unable to recommend the treatment for routine use.

Instead, it has been approved for use among a select group of patients under the Cancer Drugs Fund, which is aimed at giving patients early access to promising treatments.

NICE centre for health technology evaluation director Meindert Boysen said: ‘After relatively few developments in the past two decades for people with this type of lung cancer, this decision will be particularly welcome to those with the condition, their families and the healthcare staff and experts working with them.’

More information

Durvalumab is administered as an intravenous infusion every two weeks, until the disease starts progressing or for up to 12 months. Dose withholding or discontinuation may be needed based on individual safety and tolerability.

The dose is 10mg/kg of patients weight.

A 500mg vial has a list price of £2,466 but under its commercial agreement with the manufacturer AstraZeneca, it will be provided to the NHS at a confidential discounted price.

Expert view

Vanessa Beattie
Picture: John

Vanessa Beattie is chair, National Lung Cancer Forum for Nurses

The emergence of immunotherapies promises options for people with lung cancer. The NICE recommendation has the potential to be significantly beneficial.

While it’s generally acknowledged it will be the immuno-oncology teams that are administering the drug, lung cancer clinical nurse specialists have a crucial role in helping the patient manage their condition and treatment. Making sure they are aware of what symptoms to look out for, managing the toxicity and supporting them with their future treatment plans.

But it’s clear there is inequity in provision of care. The population of patients being assessed by a lung clinical nurse specialist is reported at 71% against an audit standard of 90%. Currently we are undertaking an audit to establish why. It is clear more effort is required to increase a depleting workforce.

Find out more

National Institute for Health and Care Excellence (2019) Durvalumab for treating locally advanced unresectable non-small-cell lung cancer after platinum-based chemoradiation

Nick Evans is a health writer 

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