Tough times for Tecentriq as NICE once again slaps down Roche's immunotherapy — slight benefit not worth price
The UK drug-pricing watchdog has again nixed Roche and its cancer immunotherapy Tecentriq.
The National Institute for Health and Care Excellence’s latest filing is for extensive-stage small cell lung cancer patients. The regulator determined that although Tecentriq appeared to improve patient survival and quality of life in clinical trials, that data was uncertain and based on patients who were dissimilar to the average NHS patient. The benefits Roche had shown were not worth the drug’s on average £32,800 (roughly $43,300) price, NICE said.
It’s the second recent price-based rejection for Roche on the isle. In October, the watchdog refused to endorse Tecentriq for triple-negative breast cancer. The Swiss giant had failed to collect trial data directly comparing the immunotherapy to current treatments, and NICE cast doubts on the models they used to extrapolate a comparison.
The rejection is a setback for Roche as it competes with AstraZeneca, Bristol-Myers Squibb and industry leader Merck, among others, in the expanding PD-(L)1 market.
Tecentriq, chemically known as atezolizumab, did pass NICE’s muster as part of a combination therapy for non-small cell lung cancer in June. Even then, though, it didn’t get the ringing endorsement Merck’s Keytruda received the year before, when NICE noted a 16-month survival benefit as a monotherapy.
NICE based their recommendations on the IMpower133 trial that showed a combination of Tecentriq and chemotherapy could boost progression-free survival from 4.3 months to 5.2 months and increase median overall survival from 10.3 months to 12.3 months.
Unlike the breast cancer trial, NICE accepted the comparison, within limits.
The trial “suggests that atezolizumab with chemotherapy could help people to live longer without their disease progressing, and to live for longer compared with chemotherapy alone,” they wrote.
But they noted that the trial included only high-performing patients — those who had an ECOG score of 0-1. They said that could not be generalized to the population of England, where many would likely have a worse score. They also said that projections of the trial data showed the placebo and treatment arms almost converged around month 30, casting doubts on the overall survival benefit.
These questions, though, ultimately had little impact on their decision, NICE said. The agency projected patients would live 4.93 months longer on average with the drug and said most models showed a median benefit around or over the 3-month benchmark for end-of-life therapies.
The cost for that benefit, though, was greater than the standard £50,000 per quality-of-life-year gained.