Issue date: June 2012
Understanding NICE guidance
Information for people who use NHS services
Erlotinib as first-line treatment for
locally advanced or metastatic
non-small-cell lung cancer
This document is about when erlotinib should be used to treat people NICE ‘technology
appraisal guidance’ with locally advanced or metastatic non-small-cell lung cancer in the advises on when NHS in England and Wales. It explains guidance (advice) from NICE and how drugs and
(the National Institute for Health and Clinical Excellence). It is written for other treatments
should be used in people with locally advanced or metastatic non-small-cell lung cancer the NHS. but it may also be useful for their families or carers or for anyone with
an interest in the condition.
It does not describe locally advanced or metastatic non-small-cell lung
cancer or the treatments in detail – your specialist should discuss these
with you. You can get more information from the organisations listed on
Information about NICE technology appraisal guidance 258 1
This may not be What has NICE said?
the only possible NICE recommends erlotinib as a possible first-line treatment (that is, treatment for
if you have not had drug treatment before) for some people with locally advanced or
metastatic non-locally advanced or metastatic non-small-cell lung cancer (see
small-cell lung below).
healthcare team Who can have erlotinib?
should talk to you You should be able to have erlotinib if you have a type of locally about whether it is
advanced or metastatic non-small-cell lung cancer that has tested suitable for you
and about other positive for mutations (changes) to EGFR-TK (which stands for
treatment options epidermal growth factor receptor tyrosine kinase) in the cancer
Why has NICE said this?
NICE looks at how well treatments work, and also at how well they
work in relation to how much they cost the NHS. NICE
recommended erlotinib because it works as well other treatments
available on the NHS, and costs about the same.
Non-small-cell lung cancer
Cancer affecting the lungs is grouped into two main types depending on
how it looks under the microscope: small-cell lung cancer and non-
small-cell lung cancer.
Symptoms of non-small-cell lung cancer include persistent coughing,
coughing up blood, shortness of breath, chest pain, tiredness and
A small sample of lung cancer tissue can be tested to check whether
the cells have EGFR-TK mutations. The EGFR-TK mutation produces a
Information about NICE technology appraisal guidance 258 2
protein that is involved in cancer cell growth and causes cancer cells to grow more quickly. If the cancer cells do have the mutations, the cancer is ‘EGFR-TK mutation-positive’. The EGFR-TK mutations make the
cancer more likely to respond to drugs that block the action of the EGFR.
Cancer that is locally advanced or metastatic has spread to the surrounding tissues or other parts of the body.
Erlotinib (also known as Tarceva) is an anticancer drug. It works by blocking the action of the EGFR, which stops the cancer growing.
What does this mean for me?
When NICE recommends a treatment, the NHS must make sure it is available to those people it could help, normally within 3 months of the guidance being issued.
So, if you have locally advanced or metastatic non-small-cell lung
cancer, and you and your doctor think that erlotinib is the right treatment
for you (see ‘What has NICE said?’ on page 2), you should be able to
have the treatment on the NHS. Please see
www.nice.org.uk/aboutguidance if you think you are eligible for the
treatment but it is not available.
Information about NICE technology appraisal guidance 258 3
The organisations below can provide more information and support for people with non-small-cell lung cancer. NICE is not responsible for the quality or accuracy of any information or advice provided by these organisations.
; British Lung Foundation, 03000 030 555
; CancerHelp UK – the patient information website of Cancer
Research UK, 0808 800 4040
; Macmillan Cancer Support, 0808 808 0000
; Marie Curie Cancer Care, 0800 716 146
; The Roy Castle Lung Cancer Foundation, 0800 358 7200
NHS Choices (www.nhs.uk) may be a good place to find out more. Your local patient advice and liaison service (usually known as ‘PALS’) may
be able to give you more information and support. If you live in Wales you should speak to NHS Direct Wales for information on who to contact.
Information about NICE technology appraisal guidance 258 4
NICE produces guidance (advice) for the NHS about preventing, diagnosing and treating medical conditions. The guidance is written by independent experts, including healthcare professionals and people representing patients and carers. They consider the evidence
on the disease and treatments, the views of patients and carers and
the experiences of doctors, nurses and other healthcare
professionals, and consider the costs involved. Staff working in the NHS are expected to follow this guidance.
To find out more about NICE, its work and how it reaches decisions, see www.nice.org.uk/aboutguidance
This document and other versions of the guidance aimed at
healthcare professionals are available at
The NICE website has a screen reader service called Browsealoud, which allows you to listen to our guidance. Click on the Browsealoud logo on the NICE website to use this service.
We encourage NHS and voluntary organisations to use text from this document in their own information about npn-small-cell lung cancer.
National Institute for Health and Clinical Excellence
Level 1A, City Tower, Piccadilly Plaza, Manchester M1 4BT; www.nice.org.uk
? National Institute for Health and Clinical Excellence, 2012. All rights reserved. This material may be freely reproduced for educational and not-for-profit purposes. No reproduction by or for commercial organisations, or for commercial purposes, is allowed without the express written permission of NICE.
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