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For the first time, NICE has recommended a targeted treatment option for ALK-positive non-small-cell lung cancer, to be given after surgery to reduce the risk of the disease coming back.

Alectinib, also known as Alecensa, is recommended as an option for the treatment of stage 1B (tumours 4cm or larger) to 3A ALK-positive non-small-cell lung cancer (NSCLC) after surgery to completely remove the tumour. 

The treatment is given as tablets, which are taken twice a day, and works by targeting cancer cells that have specific changes, called rearrangements, in the ALK gene.  

Just under 100 people in England are eligible to receive this treatment. 

Clinical trial evidence suggests people having alectinib after surgery are less likely to have their cancer come back than people having chemotherapy. 

NICE has also recommended pembrolizumab with chemotherapy before surgery (neoadjuvant) then pembrolizumab alone after surgery (adjuvant) for treating resectable non-small-cell lung cancer. 

Pembrolizumab, also known as Keytruda, is given as an infusion and is a monoclonal antibody which works by helping the person’s immune system to prevent the cancer from coming back. 
 
Clinical trial evidence shows that, compared with placebo, pembrolizumab with platinum-based chemotherapy before surgery then pembrolizumab alone after surgery decreases the likelihood of an event that would stop people having surgery or the cancer coming back after surgery. 

It also shows that people having pembrolizumab live longer than those having placebo. 

It is estimated that just over 5,000 people in England would be eligible to receive this treatment. 

NICE’s final draft guidance for this medicine is being published just over eight weeks after the treatment was granted its marketing authorisation by the Medicines and Healthcare products Regulatory Agency (MHRA). 

I am delighted that we have been able to recommend these two lung cancer treatments. 

Both treatments are designed to reduce the risk of cancer returning after surgery and demonstrate NICE’s commitment to getting the best care to patients fast and ensuring value for the taxpayer.

Helen Knight, director of medicines evaluation at NICE

Lung cancer is the third most common cancer in the UK, accounting for 13% of all new cancer cases in the UK. Non-small-cell lung cancer accounts for around 90% of all lung cancer. It is estimated that around 2 to 6% of NSCLCs have an ALK fusion genetic alteration. 

Associated guidance and resources

• Alectinib for adjuvant treatment of ALK-positive non-small-cell lung cancer [ID6368] 
• Pembrolizumab as neoadjuvant (with chemotherapy) and adjuvant (as monotherapy) treatment for resectable non-small-cell lung cancer [ID5094]