Durvalumab with etoposide and either carboplatin or cisplatin is recommended as an option for untreated extensive-stage small-cell lung cancer in adults, only if:
they have an Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1, and
the company provides durvalumab according to the commercial arrangement.
When using ECOG performance status, healthcare professionals should take into account any physical, sensory or learning disabilities, or communication difficulties that could affect ECOG performance status and make any adjustments needed.
Use the least expensive option of the available treatments (including durvalumab and atezolizumab). Take account of administration costs, dosages, price per dose and commercial arrangements. If the least expensive option is unsuitable, people with the condition and their healthcare professional should discuss the advantages and disadvantages of other treatments.
These recommendations are not intended to affect treatment with durvalumab that was started in the NHS before this guidance was published. People having treatment outside these recommendations 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 these recommendations were made
Usual first treatment for extensive-stage small-cell lung cancer is atezolizumab plus etoposide and carboplatin. Durvalumab works in a similar way to atezolizumab and may be offered to the same population. Clinical trial evidence is in people with an ECOG status of 0 or 1 (that is, they are more able to do daily tasks and ordinary activities than those with poorer ECOG status).
Durvalumab has not been directly compared in a clinical trial with atezolizumab. Indirect comparisons suggest that durvalumab is likely to work as well as atezolizumab in terms of how long people have before their cancer gets worse and how long they live.
A cost comparison suggests that durvalumab has similar or lower costs as atezolizumab, when all relevant costs are taken into account including commercial arrangements. So, durvalumab is recommended.
For all evidence see the committee papers. For more information on NICE's evaluation of atezolizumab, see the committee discussion section in NICE's technology appraisal guidance on atezolizumab with carboplatin and etoposide for untreated extensive-stage small-cell lung cancer.