CYRAMZA (ramucirumab)

• Key points

Favourable opinion for reimbursement in the first-line treatment of adult patients with metastatic non-small cell lung cancer (NSCLC) with epidermal growth factor receptor (EGFR) activating mutations, in combination with erlotinib.

• What therapeutic improvement?

No clinical added value in the first-line treatment of adult patients with metastatic non-small cell lung cancer (NSCLC) with EGFR activating mutations, in combination with erlotinib.

• Role in the care pathway?

The therapeutic arsenal for lung cancer has recently been expanded following the addition of specific treatments targeting this genome abnormality, as first-line therapy.

Hence, the current strategy for first-line treatment in the presence of an EGFR mutation in NSCLC is based on monotherapy with an anti-EGFR tyrosine kinase inhibitor (TKI) administered orally (IRESSA (gefitinib), TARCEVA (erlotinib), GIOTRIF (afatinib) and VIZIMPRO (dacomitinib)).

Due to evidence of a gain in terms of overall survival compared to erlotinib and gefitinib with a safety profile deemed to be acceptable, osimertinib is now the first-line option of choice when the use of an anti-EGFR TKI is envisaged. It was assessed in patients with EGFR exon 19 deletion or exon 21 (L858R) activating mutations and T790M mutations.

Role of CYRAMZA (ramucirumab) in the care pathway:

On the basis of currently available data and pending overall survival data (immature data at the time of assessment by the Transparency Committee), the Committee deems that the ramucirumab + erlotinib combination is a treatment option for first or later-line therapy.

However, in the current context, given new first-line therapy developments, its precise role in the care pathway remains to be defined. The decision to prescribe CYRAMZA (ramucirumab) in combination with erlotinib or an anti-EGFR tyrosine kinase inhibitor must take into account the efficacy results, the safety profile of each drug and the patient’s choice. The Committee reiterates that patients with EGFR mutations other than exon 19 deletion or exon 21 (L858R) activating mutations were not assessed in the RELAY having studied CYRAMZA (ramucirumab) in combination with erlotinib.