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Lung cancer drugs erlotinib and gefitinib under review by NICE

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The National Institute for Health and Care Excellence is reviewing its guidance on the use of two lung cancer drugs – erlotinib and gefitinib – in response to changing clinical practice.

The healthcare guidance body has issued newly updated draft guidance for consultation on the use of erlotinib and gefitinib for treating non-small-cell lung cancer that has progressed after prior chemotherapy.

Both erlotinib (Tarceva) and gefitinib (Iressa) are being provisionally recommended for patients with non-small-cell lung cancer in specific circumstances.

Existing NICE guidance recommends erlotinib with a patient access scheme as an alternative to docetaxel as a second-line treatment after the patient has had chemotherapy, but it is not recommended for patients where docetaxel is unsuitable.

The drugs – targeted therapies known as EGFR-TK inhibitors – work by blocking the signal pathways in order to help slow the growth and spread of tumours.

Since the publication of the original guidance, clinical practice has changed in that non-small-cell lung cancer patients are now tested for EGFR-TK mutation status at diagnosis so that they are given the most suitable first-line treatment.

The two drugs have already been recommended by NICE as first-line treatments when the EGFR-TK mutation test comes back positive.

A recent study directly compared erlotinib with docetaxel and it found erlotinib is less effective at extending progression-free survival in patients whose tumours test negative for the EGFR-TK mutation.

The new draft guidance therefore recommends both erlotinib and gefitinib for people who have received non-targeted chemotherapy because of delayed confirmation that their tumour is EGFR-TK mutation-positive.

Erlotinib is also recommended in this group of people with unknown EGFR-TK mutation status under certain conditions.

Sir Andrew Dillon

Sir Andrew Dillon

NICE chief executive Sir Andrew Dillon said new evidence is always the driving force behind the update of recommendations as “we have to be confident that the benefits that drugs offer patients really do justify what the NHS will have to pay for them”.

He confirmed: “This new draft guidance proposes recommending erlotinib and gefitinib for patients who have received non-targeted chemotherapy because their tumour type hadn’t yet been confirmed, and also recommends erlotinib for people with unknown EGFR-TK mutation status in certain circumstances.”

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