Osimertinib for untreated EGFR mutation-positive non-small-cell lung cancer

1.1 Osimertinib is recommended, within its marketing authorisation, as an option for untreated locally advanced or metastatic epidermal growth factor receptor (EGFR) mutation-positive non-small-cell lung cancer (NSCLC) in adults. It is recommended only if the company provides osimertinib according to the commercial arrangement.

Why the committee made this recommendation

Locally advanced or metastatic EGFR mutation-positive NSCLC is usually first treated with afatinib, erlotinib or gefitinib.

Evidence from a randomised controlled trial suggests that people who take osimertinib live longer than people who take erlotinib or gefitinib. They also live longer before their disease gets worse. There is some uncertainty about the comparison of osimertinib with afatinib, which may be more effective than erlotinib and gefitinib, because there is no direct evidence comparing them.

But, because of a new commercial arrangement, the cost-effectiveness estimates for osimertinib are within what NICE considers an acceptable use of NHS resources. So, osimertinib is recommended.