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ICR urges change as NICE rejects Keytruda plus chemotherapy

The Institute for Cancer Research (ICR) has called for change in the way immunotherapy drugs are researched and evaluated after the National Institute for Health and Care Excellence (NICE) handed MSD’s Keytruda plus chemotherapy a rejection.

Although NICE reversed a draft rejection of Keytruda (pembrolizumab) and has now recommended it for use on the NHS as a first-line treatment for head and neck cancer in PD-L1-positive patients, ICR is ‘disappointed’ that a combination of Keytruda plus chemotherapy combination was not also approved.

Researchers are concerned that while there is a group of patients who should receive single treatment with Keytruda, there is also a subgroup of patient who can now access the immunotherapy but for whom the drug may actually be associated with worse survival outcomes than standard chemotherapy.

ICR experts have called on NICE to make Keytruda available in combination with chemotherapy via the Cancer Drugs Fund (CDF) for two years. This will allow for extra data to be collected, which will aid in the identification of new biomarkers to get the right treatment to the right patients.

In addition, the ICR is urging for more routine data to be collected during immunotherapy trials to identify new biomarkers, which could help to predict patients’ response to a specific treatment.

“The partial approval leaves patients in England behind much of the world when it comes to accessing this game-changing treatment. Patients in Scotland, the rest of Europe and the US can have either single treatment or combination, at the discretion of the doctor. This decision opens up a postcode lottery within the UK,” said Kevin Harrington, professor of biological cancer therapies at the ICR and consultant clinical oncologist at The Royal Marsden NHS Foundation Trust.

“The evidence for the benefit of pembrolizumab in combination with chemotherapy in recurrent head and neck cancer is clear – and I would urge NICE and the manufacturer to work together to find a way for patients to access the range of treatment options they deserve,” he added.

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