NICE has published draft guidance which does not recommend pembrolizumab (Keytruda, MSD) with axitinib (Inlyta, Pfizer) for untreated advanced renal cell carcinoma (RCC) in adults.
First-line treatment options include tivozanib, sunitinib, pazopanib and cabozantinib which have been previously recommended for routine commissioning by NICE. Nivolumab with ipilimumab is recommended for use in the Cancer Drugs Fund.
Although the evidence suggests pembrolizumab with axitinib would be welcomed by patients, there was uncertainty around the long-term benefit. Clinical and cost-effectiveness estimates were also above what NICE would normally consider as an acceptable use of NHS resources.
Approximately 12,900 people are diagnosed with kidney cancer each year in the UK with the most common type being RCC. It accounts for 80% of kidney cancer cases and 3% of all cancer cases in the UK.
Pembrolizumab is given intravenously every 3 weeks and axitinib is taken orally twice a day. The list prices of pembrolizumab and axitinib are £2630 per vial (100 mg) and £3517 for 56 tablets (5 mg). The companies have confidential commercial arrangements which would have made these drugs available to the NHS with a discount.
The guidance is open for public consultation until 4 March 2020.