Groundbreaking drug could cut the chance of lung cancer coming back by a third if used alongside chemotherapy and surgery. So why have NHS bosses rejected it?

NHS chiefs have been urged to reverse their decision to reject a groundbreaking lung cancer drug that cuts the risk of the disease returning by a third.

Research has shown that Durvalumab is effective in curing patients with the most common form of lung cancer when combined with chemotherapy and surgery in the early stages of the disease.

US health authorities last month approved the £70,000-a-year infusion for this patient group, which has benefited thousands of people.

It is already offered by the NHS for people with advanced lung cancer that has spread throughout the body and is not responding to other treatments.

However, experts were shocked two weeks ago when the NHS spending watchdog, the National Institute for Health and Care Excellence (NICE), concluded that it would not follow the US lead and approve durvalumab for early-stage lung cancer.

It was stated that it was unclear to what extent the drug is more effective than existing treatments.

But experts disagree, saying NICE should reconsider its position and allow around 1,500 patients a year to benefit.

Dr John Conibear, clinical oncologist at Barts Cancer Centre, said: ‘Durvalumab is a very important step forward for a patient group who desperately need more options.

‘The risk of cancer coming back in these patients is high, even after surgery. Furthermore, we know that giving durvalumab before and after surgery significantly extends the time patients remain cancer-free.

‘It is disappointing that NICE has chosen not to approve it and I hope they will reconsider the decision.’

In the UK, someone is diagnosed with lung cancer every ten minutes – around 50,000 new patients a year – and only a quarter survive five years.

Around 35,000 people die from it each year, making it the UK’s biggest cancer killer. The most common form of the disease is non-small cell lung cancer, which accounts for around 80 per cent of new cases.

This form of cancer is mainly caused by smoking and is most common in people between the ages of 60 and 70.

Trials have shown that Durvalumab is effective in curing patients with the most common form of lung cancer when combined with chemotherapy and surgery in the early stages of the disease (stock photo0

When the disease is detected before it has spread beyond the lungs, it is treated with a combination of chemotherapy, an immune-boosting drug called nivolumab, and then surgery to remove the tumors.

However, in more than half of people, the disease returns within five years.

When this happens, the disease becomes more resistant to conventional treatments and most patients do not survive longer than three years after this happens.

Durvalumab is a PD-L1 inhibitor, which means it helps the body detect cancer cells that are hiding from the immune system so it can target and destroy them.

It is given as four monthly infusions in addition to chemotherapy before surgery, and then as monotherapy after surgery for a further year.

Data from an international study of 800 participants in 2023 found that the risk of cancer returning or patients dying is reduced by 32 percent over a four-year period compared to chemotherapy alone.

However, NICE states that the study does not directly compare the effectiveness of durvalumab with the existing drug nivolumab. It cannot therefore say for sure whether the drug is worth its high price.

Nivolumab, first approved for lung cancer in 2017, costs around £68,000 per course.

NICE was also concerned about a recent study which found that one in five patients experienced side effects including nausea, constipation, fatigue and muscle pain.

Similar side effects are observed in approximately one in ten nivolumab patients.

Durvalumab is a PD-L1 inhibitor, which means it helps the body recognize cancer cells that are hiding from the immune system so it can target and destroy them (stock photo)

However, experts say further long-term data on durvalumab will likely show it to be more effective than nivolumab.

Dr Conibear said: ‘We are seeing a significant reduction in the risk of tumours coming back in patients with advanced lung cancer who are already receiving durvalumab on the NHS, and doctors are now considering it a cornerstone of treatment.

‘The hope is that this will also enable us to cure more patients at an early stage.

‘Patients’ lives are really hard, even after they get the ‘all is well’ signal. They spend their lives in constant fear of what the next scan will find.

‘It is unacceptable that lung cancer returns in 30 to 50 percent of patients.

“If we can approve a drug that can reduce that number and cure more people, then that’s a bonus.”

A spokesman for Astrazeneca, the British pharmaceutical company that developed durvalumab, said it was “working to provide additional data” to NICE so these issues can be addressed in time for mid-September, when the watchdog makes a final decision on the drug.

A NICE spokesperson said: ‘It is important to note that this is not NICE’s final guidance for this technology. The recommendations may change following consultation.’