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?
Mon, 10/22/2012 - 02:47
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):
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:
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.
Mon, 10/22/2012 - 14:28
"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.
Mon, 10/22/2012 - 16:47
No, that's great -- thanks!
Tue, 10/23/2012 - 01:58
Brilliant - thank you Janine.
That guidance (TA 162) is from 2008, and that's what is now being reviewed.