NICE is set to reject Eli Lilly’s Cyramza for the treatment of gastric cancer on the grounds that it does not represent value for money.
The Institute’s appraisal consultation document does not recommend Cyramza (ramucirumab), either alone or in combination with paclitaxel for pre-treated advanced gastric cancer or gastro-oesophageal junction adenocarcinoma.
The decision was based on two trials, one of which, called RAINBOW, demonstrated an extension to life of 2.3 median months for Cyramza plus paclitaxel compared with paclitaxel plus best supportive care.
The other trial, called REGARD, trial showed that Cyramza monotherapy plus best supportive care extended life by 1.4 months versus placebo plus best supportive care.
However, the cost of the drug – which averages £42,000 per patient – produced to an incremental cost-effectiveness ratio (ICER) for Cyramza plus paclitaxel at £408,200 per quality-adjusted life year (QALY), which far exceeds norms for NICE-recommended medications.
Additionally, the ICER for Cyramza alone compared with best supportive care was £188,100 per QALY gained, which too is far above benchmarks concerning value for money.
There are currently no patient access schemes for Cyramza and NICE’s appraisal committee concluded that end-of-life considerations could not be applied to the drug, denying that access benefit.
Cyramza is an injectable therapy – a VEGFR2 antagonist that works by blocking blood supply that fuels tumour growth.
The EMA approved Cyramza as a second-line therapy for gastric cancer at the end of 2014 and this came shortly after it was also approved for non-small cell lung cancer in the US.
Analysts have previously stated that they expect annual sales of $2bn for the drug.