Scottish lung cancer patients to access immunotherapy/ chemotherapy combination

image of lungs, the left lung is bordered by orange, the right by blue to show AstraZeneca's Tagrisso▼ (osimertinib) rejected by NICE for use in NHS England

MSD has announced that the Scottish Medicines Consortium (SMC) has accepted KEYTRUDA®▼ (pembrolizumab) in combination with carboplatin and paclitaxel chemotherapy for the first-line treatment of metastatic squamous non-small cell lung cancer (NSCLC) for restricted use in Scotland.

The SMC has accepted this treatment for patients whose tumours express programmed death ligand 1 (PD-L1) with a <50% tumour proportion score (TPS), or in those whom it has not been possible to evaluate PD-L1 TPS. Treatment with pembrolizumab is subject to a two-year stopping rule.

Now, for the first time, patients with this difficult-to-treat form of lung cancer will have access to pembrolizumab in combination with chemotherapy across the UK, rather than having to wait to finish a course of chemotherapy.

This approval makes pembrolizumab the first immunotherapy to be approved for use in the first-line setting for Scottish patients with metastatic squamous NSCLC when combined with carboplatin and paclitaxel chemotherapy. Pembrolizumab in combination with carboplatin and either paclitaxel or nab-paclitaxel is indicated for the first-line treatment of metastatic squamous NSCLC in adults.

Lung cancer is the most common cause of death in both men and women in Scotland. 5331 cases were diagnosed in 2017 – 16.5% of all cases of cancer diagnosed that year. It is the leading cause of cancer-related death and in 2017 accounted for a quarter (25.3%) of deaths caused by all cancers.

Dr Brian Clark, Consultant Clinical Oncologist at the Beatson West of Scotland Cancer Centre, said: “Due to the difficult-to-treat nature of squamous NSCLC, most Scottish patients have, to date, only had access to immunotherapy after chemotherapy.

“Treatment with pembrolizumab combined with chemotherapy is showing significant improvements in overall survival and we have found that response rates are significantly higher at 58% with a chemotherapy/immunotherapy combination, compared to 35% for chemotherapy alone. This approval is a hugely positive result for this group of Scottish lung cancer patients, for which this first line treatment option has not been available until now.”

Paula Chadwick, CEO, Roy Castle Lung Cancer Foundation, said: “We are delighted that Scottish patients with squamous NSCLC will now be able to receive pembrolizumab.”

John McNeill, Devolved Nations Director, MSD, said: “MSD has worked collaboratively with the SMC and NHS Scotland to broaden access to a beneficial treatment option to another subset of patients with lung cancer, which has the potential to increase survival.”