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Pfizer's Xalkori sees rejection at the hands of NICE in lung cancer

Published on 19/01/18 at 09:17am

UK regulator NICE has announced its decision not to recommend Pfizer’s Xalkori (crizotinib) for use on the NHS in the treatment of ROS1-positive advanced non-small cell lung cancer (NSCLC) in both previously treated patients and those yet to receive treatment, asserting that the drug could not be considered value for money.

The organisation’s reasoning was that Xalkori would cost “well over £50,000 per QALY (quality-adjusted life year), in addition to the fact that, though it noted that “one cost-effectiveness estimate is possibly within the range that NICE normally considers acceptable for end-of-life treatments”, the data provided by Pfizer to support the application was too judged uncertain.

The data submitted by Pfizer was derived from a small, single arm study which predominantly focused on patients with previously treated disease. “The lack of data comparing crizotinib with ‘standard care’ makes any assessment of relative effectiveness very challenging,” NICE said.

Because of this uncertainty, NICE has requested that Pfizer submit a proposal for Xalkori to be included on the Cancer Drugs Fund, where additional data could be gathered on its use to support a future reapplication.

“This would allow further clinical data to be collected on the demographics of people with ROS1-positive advanced NSCLC, treatment length and the survival benefit (progression-free and overall) with crizotinib,” NICE added.

A Pfizer spokeswoman commented: “This is a particularly rare and largely unknown type of lung cancer which therefore presents challenges in the NICE appraisal process, but we are committed to ongoing collaboration with all parties to reach a positive outcome.”

Xalkori was knocked back on the basis of price back in 2013, but Pfizer eventually managed to secure a recommendation with an additional price cut.

Matt Fellows

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