1 Recommendation
1.1
Durvalumab is recommended, within its marketing authorisation, as neoadjuvant treatment with platinum-based chemotherapy, then continued alone as adjuvant treatment, for treating non-small-cell lung cancer (NSCLC) in adults whose cancer:
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is resectable (tumours 4 cm or over, or node positive) and
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has no epidermal growth factor receptor (EGFR) mutations or anaplastic lymphoma kinase (ALK) rearrangements.
Durvalumab is only recommended if the company provides it according to the commercial arrangement.
Why the committee made this recommendation
Usual treatment for resectable NSCLC is nivolumab with chemotherapy then surgery. A resectable tumour is one that can be removed surgically.
Clinical trial evidence shows that, compared with placebo, durvalumab with platinum-based chemotherapy before surgery (neoadjuvant) then alone after surgery (adjuvant) decreases the likelihood of:
an event that would stop people having surgery (for example, the cancer getting worse), and
the cancer coming back after surgery.
Durvalumab has not been directly compared in a clinical trial with usual treatment. An indirect comparison suggests that neoadjuvant and then adjuvant durvalumab may reduce the likelihood of the cancer getting worse or coming back after surgery compared with neoadjuvant nivolumab, but this is uncertain.
The cost-effectiveness estimates for neoadjuvant and then adjuvant durvalumab compared with neoadjuvant nivolumab and chemotherapy are within the range NICE considers an acceptable use of NHS resources. So, perioperative durvalumab with chemotherapy is recommended.