UK's NICE recommends Pfizer's Inlyta for kidney cancer

UK health costs watchdog the National Institute for Health and Care Excellence (NICE) has issued new final draft guidance recommending National Health Service use of US pharma giant Pfizer’s (NYSE: PFE) Inlyta (axitinib), for advanced kidney cancer.

NICE, which previously issued negative guidance on Inlyta but  reversed this in a preliminary guidance earlier this year, has previously recommended two drugs for advanced renal cell carcinoma, sunitinib (Pfizer’s Sutent) and pazopanib (GlaxoSmithKline’s Votrient) - both as first-line treatments.

“NICE was asked by the Department of Health to look at axitinib for people who have already been treated with a cytokine or a drug known as a kinase inhibitor. This draft guidance recommends that the NHS provides axitinib for these patients. Although, this recommendation has not changed since the previous draft guidance, the updated draft includes some clarification around prescribing axitinib,” said Carole Longson, Health Technology Evaluation Centre director, adding: “The independent appraisal committee carefully considered the available evidence, including the discount offered by the company that market the drug and concluded that axitinib should be offered by the NHS.”

NICE was asked by the Department of Health to look at the use of axitinib within its licensed indication for those previously treated with sunitinib (a kinase inhibitor), the use of axitinib after treatment with other tyrosine kinase inhibitors, such as pazopanib, is not subject to statutory funding.

The draft guidance is now with consultees, who have the opportunity to appeal against it. Until NICE issues final guidance, NHS bodies should make decisions locally on the funding of specific treatments.

Cost structure and patient access scheme

The NICE Appraisal Committee concluded that the most plausible cost per QALY (Quality Adjusted Life Year) for axitinib after sunitinib would be around halfway between £33,500 ($52,595) and £52,900, and after cytokine £33,000. After a cytokine £55,300 per QALY.

Axitinib is available in 1mg and 5mg film-coated tablets at net prices of £703.40 and £3,517 per 56-tablet pack. It is administered orally at a recommended starting dose of 5mg twice daily. This dose may be increased to 7mg and then up to 10mg, or decreased to 3mg and then down to 2mg, depending on individual safety and tolerability. Pfizer has agreed a patient access scheme with the Department of Health. The size of the discount is commercial in confidence.