Our oncology team has been doing a lot of work recently in locally advanced and metastatic Non-Small Cell Lung Cancer. Two big immunotherapy brands now have licences. A third will soon add a further challenge.
With trial data hard to pull apart, it seems likely that NICE decisions around funding in tightly defined patient groups will be fundamental in shaping the UK market.
It looks likely that market shares could ultimately be determined by whether guidelines award access to all-comers or restrict usage to patients with specific levels of PD-1 or PD-L1 expression. Brands are preparing for a range of possibilities and the final access arrangements are likely to be quite complex, with clinicians needing to determine expression levels before they can establish which treatment a patient is eligible for.
To add further complication, Adelphi Real World’s recent Disease Specific Programme data suggests that the need for PD-1/PD-L1 testing could prove to be a significant logistical barrier. The data shows that for EGFR and ALK testing, insufficient biopsy tissue was an issue for 1 in every 8 cases.
Additionally, PD-1/PD-L1 testing would lengthen the time to treatment initiation. Physicians already indicate they wait 10 days on average for biomarker test results – and with time an obvious concern for cancer patients, a treatment that avoids delay will have a significant advantage.
Based on this, it looks likely that any brand that can gain all-comers access will not only have access to a far wider patient population, but is also likely to gain wider use across patient groups in preference to competitors, as there will be no need to test.
Here at Adelphi, we’re watching out for the NICE updates with bated breath
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