Nice's decision on erlotinib depends on its cost comparison with gefitinib

Source: Elsevier 2012-02-21 the cost benefit management agency in England and Wales issued a new draft of guidance, pointing out that erlotinib cannot be recommended as the first-line treatment for advanced or metastatic EFGR mutation positive non-small cell lung cancer (NSCLC) Nice stressed that the draft guidance on erlotinib (troika, Roche) is still at an early stage, but has asked manufacturers for more information In particular, cost-benefit comparisons with gefitinib (Iresa, AstraZeneca and TIWA) are needed, and gefitinib is currently the recommended treatment for such patients Erlotinib and gefitinib are both oral drugs that work by blocking EGFR signaling In January, the Scottish Drug Administration advised the national health service in Scotland to use erlotinib in patients with advanced or metastatic EFGR positive NSCLC The proposal is based on a phase III open trial in European patients that included 173 patients with advanced or metastatic NSCLC and activated EGFR mutations who were randomized to erlotinib or platinum based chemotherapy (ASCO 2011 Abstract 7503) In a recent follow-up evaluation by the Scottish regulatory agency, median progression free survival was 9.7 and 5.2 months in the erlotinib and chemotherapy groups, respectively [hazard ratio (HR) 0.37; 95% confidence interval (CI), 0.27-0.54; P < 0.0001] The Scottish reviewers also considered evidence from a Chinese study (n = 155) designed to compare erlotinib monotherapy with platinum based chemotherapy (Lancet Oncology 2011; 12:735-42) The median progression free survival of erlotinib and gemcitabine / carboplatin groups was 13.7 and 4.6 months, respectively (HR 0.164; P < 0.0001) In a press release, nice did not mention the clinical evidence supporting erlotinib, but pointed out: "how the cost-effectiveness of erlotinib changes depends on how many patients can continue to receive erlotinib and gefitinib after 60 days of treatment, which requires further sensitivity analysis." For patients who can continue to receive treatment after 32 months, gefitinib is provided to the NHS at a fixed fee of £ 12200 per patient; for patients who receive gefitinib for less than 2 months, no fee will be charged Erlotinib was used in tablet form with a standard dose of 150 mg / d At present, the cost of erlotini for 30 pieces per box is £ 1631.53; however, the manufacturer of erlotini has agreed to a discount scheme, and the specific cost has not yet been announced by nice