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NICE rejects BMS cancer drug in draft guidance

Published on 16/12/15 at 09:13am
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NICE says Opdivo cannot be considered a cost-effective use of NHS money

In draft guidance, NICE has chosen not to recommend Bristol-Myers Squibb’s Opdivo for the treatment of locally advanced or metastatic squamous non-small-cell lung cancer after prior chemotherapy in adults. 

While the NICE Committee recognised the clinical efficacy of Opdivo (nivolumab) in previously-treated squamous non-small-cell lung cancer (NSCLC), as well as its innovative nature and the fact that the drug met the criteria to be considered a life-extending, end-of-life treatment, the Institute did not consider it a cost-effective use of NHS resources. It calculated a likely incremental cost-effectiveness ratio (ICER) for the treatment compared with Sanofi’s Taxotere (docetaxel) of between £109,000 and £129,000 per quality-adjusted life year (QALY) gained. 

The Committee recognised that Taxotere – the current standard of treatment – is often not well tolerated, and that there are few alternatives, meaning there is an important unmet need for people with squamous NSCLC whose disease has progressed after chemotherapy. 

However, BMS’ evidence, from the randomised CheckMate-017 trial and three non-randomised trials, failed to persuade the Committee of Opdivo’s superiority to existing treatments on health-related quality-of-life outcomes. It also stated that Opdivo’s clinical effectiveness compared with Genentech’s Tarceva (erlotinib) and best supportive care remains unknown.

A NICE spokesperson says: “Our independent advisory committee recognised that nivolumab is a promising new treatment. However, even allowing for the extra flexibility they have for making recommendations about new cancer treatments, it could not be considered a cost-effective use of NHS resources.”

Bristol-Myers Squibb responded to the decision, saying it could deny some lung cancer patients “one of the most significant advances in almost 20 years.” As evidence, the company cited trial data where Opdivo was shown to achieve significantly superior survival rates, with 42% of patients still alive at one year, compared with 24% of those treated with Taxotere. 

BMS pointed out that if the draft guidance becomes final, it will mean that treatment options for these patients will remain limited to chemotherapies including Taxotere, which was first approved for use 17 years ago. It also noted that lung cancer survival rates in the UK lag almost a decade behind some European countries, citing Macmillan Cancer statistics. 

Johanna Mercier, general manager, Bristol-Myers Squibb UK and Ireland, says: “Today’s draft decision is deeply disappointing for lung cancer patients, and for us, as we have worked extensively with the UK Health Authorities to enable prompt patient access to nivolumab. We have made this pioneering medicine available both through our clinical trial programme and through the Early Access to Medicines Scheme. We are continuing to work with NICE to facilitate access for patients who urgently need it.” 

Professor Dean Fennell, chair of thoracic medical oncology at the University of Leicester, also reacted with disappointment to the decision, saying: “Clinicians have long-awaited a medicine that could extend survival for patients in the advanced stages of the disease. If it is not reversed as soon as possible, the draft recommendation issued today could be a serious blow to lung cancer patients, many of whom can’t afford to wait.” 

Professor Paul Workman, chief executive of The Institute of Cancer Research, London, called on drug companies to stop setting "very high prices for promising immunotherapies."

"At this price [Opdivo] is very clearly too expensive for the NHS to afford. I'd like to see the Government, NICE and drug companies working together to bring down the cost of immunotherapies to more realistic prices.... New drug combinations will be a cornerstone of the improvements we make in cancer survival rates over the next ten years, and while innovative drugs should command relatively higher prices, the overall cost of treatment must be affordable."

Joel Levy

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