1 Recommendations

1.1 Atezolizumab is recommended for use within the Cancer Drugs Fund as an option for adjuvant treatment after complete tumour resection in adults with stage 2 to 3a non-small-cell lung cancer (NSCLC) whose:

tumours have the programmed cell death ligand‑1 (PD‑L1) biomarker expression on 50% or more of their tumour cells and
whose disease has not progressed after platinum-based adjuvant chemotherapy.

It is recommended only if the company provides atezolizumab according to the managed access agreement.

1.2 This recommendation is not intended to affect treatment with atezolizumab 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 clinician consider it appropriate to stop.

Why the committee made these recommendations

There are no immunotherapy treatments available in England for NSCLC after complete tumour resection.

Clinical trial evidence shows that compared with active monitoring, atezolizumab reduces the risk of the disease coming back. It may also lower the risk of death. However, this evidence is uncertain because the available data is still immature. Also, the company's model structure did not fully capture expected outcomes from more advanced disease health states.

Because of this, the cost-effectiveness estimates for atezolizumab are also uncertain. It has the potential to be cost effective, but more evidence is needed to address these uncertainties before it can be recommended for routine use.

Because more data is being collected that addresses these uncertainties, atezolizumab is recommended for use in the Cancer Drugs Fund.