The UK's National Institute for Health and Care Excellence (NICE) announced it cannot make a recommendation regarding the use of atezolizumab (Tecentriq) for untreated advanced or recurrent non-small-cell lung cancer (NSCLC) in adults unsuitable for platinum-doublet chemotherapy. The decision comes after Roche Products, the manufacturer, confirmed it would not submit evidence for the appraisal.
According to NICE's statement, Roche believes there is "unlikely to be enough evidence that the technology is a cost-effective use of NHS resources in this population." This terminated appraisal means the immunotherapy treatment will not be routinely available through the National Health Service (NHS) for this specific patient group.
Impact on Treatment Landscape
Non-small-cell lung cancer represents approximately 85% of all lung cancer cases and remains one of the leading causes of cancer-related deaths worldwide. For patients with advanced or recurrent disease who cannot tolerate platinum-based chemotherapy regimens due to comorbidities, poor performance status, or other factors, treatment options are already limited.
Atezolizumab, a PD-L1 inhibitor that helps the immune system identify and attack cancer cells, has shown efficacy in various NSCLC settings. However, without NICE approval, UK clinicians will need to continue relying on existing treatment protocols for this vulnerable patient population.
Regulatory and Economic Considerations
The decision highlights the complex interplay between clinical efficacy, economic considerations, and regulatory processes. Pharmaceutical companies must demonstrate both clinical effectiveness and cost-effectiveness to secure NICE recommendations, which influence NHS funding decisions.
"This is a commercial decision by Roche based on their assessment of the available data and the UK health technology assessment requirements," said a healthcare policy expert familiar with NICE processes but not directly involved in this case. "Unfortunately, it's the patients with limited options who ultimately feel the impact of these decisions."
Future Possibilities
NICE has indicated it will review this decision if Roche decides to make an evidence submission in the future. The guidance was last reviewed on March 12, 2025, suggesting that the door remains open for reconsideration should new data emerge or if the company changes its position.
For patients with untreated advanced or recurrent NSCLC who cannot receive platinum-doublet chemotherapy, clinical trials and other treatment approaches will continue to be explored. Meanwhile, atezolizumab remains available through the NHS for other approved indications in lung cancer and other tumor types where NICE has issued positive recommendations.
Healthcare professionals are advised to consult current NICE guidance for the most up-to-date recommendations on managing NSCLC in patients unsuitable for standard chemotherapy regimens.
