1 Recommendations

1.1

Atezolizumab can be used, within its marketing authorisation, as an option for the adjuvant treatment of non-small-cell lung cancer (NSCLC) after complete resection and platinum-based chemotherapy in adults when:

there is a high risk of recurrence
50% or more of tumour cells express PD‑L1
the cancer is not epidermal growth factor receptor (EGFR)‑mutant or anaplastic lymphoma kinase (ALK)‑positive.

Atezolizumab can only be used if the company provides it according to the commercial arrangement.

1.2

If people with the condition and their healthcare professional consider atezolizumab to be 1 of a range of suitable treatments, after discussing the advantages and disadvantages of all the options, the least expensive should be used. Administration costs, dosages, price per dose and commercial arrangements should all be taken into account.

What this means in practice

Atezolizumab must be funded in the NHS in England for the condition and population in the recommendations, if it is considered the most suitable treatment option. Atezolizumab must be funded in England within 30 days of final publication of this guidance.

There is enough evidence to show that atezolizumab provides benefits and value for money, so it can be used routinely across the NHS in this population.

NICE has produced tools and resources to support the implementation of this guidance.

Why these recommendations were made

This evaluation reviews the evidence for atezolizumab for the adjuvant treatment of resected NSCLC (NICE technology appraisal guidance TA823). It also reviews new data collected as part of the managed access agreement, which includes evidence from clinical trials.

Usual adjuvant treatment after complete resection and platinum-based chemotherapy of NSCLC is pembrolizumab, a monoclonal antibody. Atezolizumab works in a similar way and is an alternative to pembrolizumab.

Clinical trial evidence shows that atezolizumab increases how long people live compared with active monitoring. Atezolizumab has not been directly compared in a clinical trial with pembrolizumab. But indirect comparisons suggest that it is likely to work at least as well in terms of how long people live cancer-free and how long they live.

A cost comparison suggests that the costs for atezolizumab are similar to or less than those for pembrolizumab. Administration, adverse-event and other resource-use costs are also expected to be similar to or less than those for pembrolizumab. To be recommended as a treatment option, atezolizumab must cost less or have similar costs to 1 relevant comparator recommended in a published NICE technology appraisal guidance (see NICE's cost-comparison methods), so atezolizumab can be used.

For all evidence, see the committee papers. For more information on NICE's evaluation of pembrolizumab, see the committee discussion section in NICE's technology appraisal guidance on pembrolizumab for adjuvant treatment of resected NSCLC.