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Osimertinib with pemetrexed and platinum-based chemotherapy for untreated EGFR mutation-positive advanced non-small-cell lung cancer [ID6328]

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1 Recommendations

1.1

Osimertinib with pemetrexed and platinum-based chemotherapy is not recommended, within its marketing authorisation, for untreated advanced non-small-cell lung cancer (NSCLC) in adults whose tumours have epidermal growth factor receptor (EGFR) exon 19 deletions or exon 21 (L858R) substitution mutations.

1.2

This recommendation is not intended to affect treatment with osimertinib with pemetrexed and platinum-based chemotherapy that was started in the NHS before this guidance was published. People having treatment outside this recommendation may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS healthcare professional consider it appropriate to stop.

Why the committee made these recommendations

Usual treatment for untreated advanced NSCLC with EGFR mutations is osimertinib alone.

Clinical trial evidence shows that, compared with osimertinib alone, osimertinib with pemetrexed and platinum-based chemotherapy increases how long people have before their cancer gets worse and how long they live. But the effect on how long people live is uncertain because there is limited clinical trial evidence.

There are also issues with the assumptions used in the economic model. These include:

  • how long people live

  • how long people have the treatment

  • quality of life before the cancer gets worse.

Because of the uncertainties in the economic model, it is not possible to determine the most likely cost-effectiveness estimates for osimertinib with pemetrexed and platinum-based chemotherapy. So, it has not been shown to be a cost-effective option and it is not recommended.