2 The technology

Description of the technology	Necitumumab (Portrazza, Eli Lilly) is a fully human monoclonal antibody, which inhibits the epidermal growth factor receptor (EGFR).
Marketing authorisation	Necitumumab has a marketing authorisation in the UK, in combination with gemcitabine and cisplatin chemotherapy, for treating locally advanced or metastatic EGFR-expressing squamous non-small-cell lung cancer (NSCLC), in adults who have not had chemotherapy for this condition.
Adverse reactions	The most common adverse reactions associated with necitumumab include skin reactions, venous thromboembolic events and laboratory abnormalities (hypomagnesaemia and albumin-corrected hypocalcaemia). For full details of adverse reactions and contraindications, see the summary of product characteristics.
Recommended dose and schedule	Necitumumab is given by intravenous infusion, at a dose of 800 mg on days 1 and 8 of each 3‑week cycle.
Price	Necitumumab is available at a list price of £1,450 per 800‑mg vial (excluding VAT; company submission). This equates to £2,900 per cycle, and an average of £30,740 per course (excluding the cost of gemcitabine and cisplatin; based on an average of 4.6 cycles per course for induction therapy and 6 cycles per course for maintenance therapy). The company has agreed a patient access scheme with the Department of Health. If necitumumab had been recommended, this scheme would provide a simple discount to the list price of necitumumab with the discount applied at the point of purchase or invoice. The level of the discount is commercial in confidence. The Department of Health considered that this patient access scheme would not constitute an excessive administrative burden on the NHS.