A further set of updated draft guidance has been published, following a previous consultation. The new draft guidance provisionally recommends erlotinib as a treatment option for people with non-small-cell lung cancer that has progressed after prior chemotherapy in specific circumstances – but does not recommend gefitinib.

Both erlotinib and gefitinib are targeted therapies known as EGFR-TK inhibitors, they work by blocking the signal pathways helping to slow the growth and spread of tumours.

Existing NICE guidance recommends erlotinib with a patient access scheme as an alternative to docetaxel as a ‘second-line’ treatment after prior chemotherapy, however it is not recommended in people for whom docetaxel is unsuitable (NICE technology appraisal guidance 162). NICE was unable to make a recommendation on gefitinib for second-line treatment because no evidence submission was received from the manufacturer (NICE technology appraisal guidance 175).

Clinical practice has changed since the original guidance on erlotinib and gefitinib was published; people with non-small-cell lung cancer have their tumour tested for EGFR-TK mutation status at diagnosis before receiving ‘first-line’ therapy to ensure that the most appropriate treatment is selected.

NICE has already recommended these two drugs as first-line treatments in people whose tumours are EGFR-TK mutation-positive. However clinical specialists told the independent advisory committee that in clinical practice, where this group of patients have received erlotinib and gefitinib as first-line treatment, it is unlikely that they would be re-treated with an EGFR-TK inhibitor as part of second-line treatment because of reduced sensitivity of the tumour to these drugs. Clinical specialists also told the committee that a small group of patients may receive a delayed diagnosis of mutation status. Some of these patients have stable disease and it is possible to wait for 2 weeks for the diagnostic test result, but patients with aggressive disease need immediate treatment before EGFR-TK mutation status is confirmed.

For more details, go to: https://www.nice.org.uk/News/Press-and-Media/nice-consults-again-on-updated-guidance-for-two-lung-cancer-drugs