NICE has published Technology Appraisal (TA) Guidance 653 and 654 on osimertinib for the treatment of non-small-cell lung cancer (NSCLC).
TA653, Osimertinib for treating EGFR T790M mutation-positive advanced non-small-cell lung cancer, provides evidence-based recommendations on the use of osimertinib for the treatment of epidermal growth factor receptor (EGFR) T790M mutation-positive locally advanced or metastatic NSCLC in adults. TA654, Osimertinib for untreated EGFR mutation-positive non-small-cell lung cancer, covers the use of osimertinib for untreated locally advanced or metastatic EGFR mutation-positive NSCLC in adults.
People with EGFR T790M mutation-positive NSCLC tend to be younger, have usually never smoked, and are often diagnosed at an advanced disease stage. Only 1% of the EGFR mutation-positive population has the T790M mutation present at diagnosis and osimertinib would very rarely be used in this setting. However, osimertinib and other tyrosine kinase inhibitors are better tolerated than platinum doublet chemotherapy (PDC). In addition, patients on PDC have worse clinical outcomes and more rapid disease progression than those taking osimertinib. Therefore, despite uncertainties around efficacy, osimertinib has been approved for use in the NHS for both indications.