What are UK’s NICE guidelines for EGFR mutation negative patients and Tarceva?

Portal Forums Cancer Basics Oncology Economics/Industry/Policy What are UK’s NICE guidelines for EGFR mutation negative patients and Tarceva?

This topic contains 4 replies, has 3 voices, and was last updated by  certain spring 5 years ago.

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October 21, 2012 at 5:48 pm  #1249335    
Dr West
Dr West

Because I don’t practice in the UK, I haven’t kept up with NICE guidelines for Tarceva (erlotinib) use in EGFR mutation negative (“wild type”) patients receiving second line or later therapy. Can someone UK-based let me know whether Tarceva is permitted for those patients with advanced NSCLC and without an EGFR mutation?

Thanks,
Dr. West

October 22, 2012 at 2:47 am  #1249344    

certain spring

It’s really confusing, and I would welcome input from anyone who knows more about this than I do.
My understanding is that, since June 2011, Tarceva is not recommended for maintenance for stable disease after first-line chemotherapy (Technology assessment #227):

http://guidance.nice.org.uk/TA227

This is based on cost considerations and a clinical discussion of the SATURN trial.
What I am not sure about is whether Tarceva is recommended as a second-line treatment for metastatic lung cancer that has progressed through first-line chemotherapy. As far as I can tell, NICE have just started looking at that, with a prospective guidance issue date of June 2014:

http://guidance.nice.org.uk/TA/WaveR/138#schedule

In practice, there are certainly patients who are being given second-line Tarceva by their oncologists when their disease progresses. But I don’t know whether that includes people without the EGFR mutation, or people who have not been tested. I will try and clarify this, or perhaps a professional or another patient can provide a more authoritative answer.


49-year-old non-smoker, dx stage IV NSCLC May 2010 (squamous tumour of the left lung with multiple brain metastases). Radiotherapy to chest and brain; progressed through two cycles carbo/gemcitabine. Repeated lung collapses; pneumonia in collapsed lung, Nov 2010; bronchial stent placed, Dec 2010. Declined second-line Taxotere. Mutation testing Feb 2011, surprise EGFR exon deletion 19. Started Tarceva (150mg), Feb 2011. Progression in liver and elsewhere, May 2013.

October 22, 2012 at 2:28 pm  #1249364    
catdander forum moderator
catdander forum moderator

http://publications.nice.org.uk/erlotinib-for-the-treatment-of-non-small-cell-lung-cancer-ta162

“1.1 Erlotinib is recommended, within its licensed indication, as an alternative to docetaxel as a second-line treatment option for patients with non-small-cell lung cancer (NSCLC) only on the basis that it is provided by the manufacturer at an overall treatment cost (including administration, adverse events and monitoring costs) equal to that of docetaxel.”
There seems to be some restrictions but I don’t see mutation status as one. But since this is my first look into this healthcare I’m probably not a good judge at what I’m looking at.

October 22, 2012 at 4:47 pm  #1249370    
Dr West
Dr West

No, that’s great — thanks!

October 23, 2012 at 1:58 am  #1249376    

certain spring

Brilliant – thank you Janine.
That guidance (TA 162) is from 2008, and that’s what is now being reviewed.


49-year-old non-smoker, dx stage IV NSCLC May 2010 (squamous tumour of the left lung with multiple brain metastases). Radiotherapy to chest and brain; progressed through two cycles carbo/gemcitabine. Repeated lung collapses; pneumonia in collapsed lung, Nov 2010; bronchial stent placed, Dec 2010. Declined second-line Taxotere. Mutation testing Feb 2011, surprise EGFR exon deletion 19. Started Tarceva (150mg), Feb 2011. Progression in liver and elsewhere, May 2013.

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