, 2025-05-16 09:54:00
Two monoclonal antibody targeted therapies have been recommended for routine NHS use in England by the National Institute for Health and Care Excellence (NICE).
Spesolimab has been endorsed for treating generalised pustular psoriasis (GPP). Atezolizumab has been recommended as adjuvant therapy for non-small-cell lung cancer (NSCLC).
Spesolimab for Generalised Pustular Psoriasis
Spesolimab (Spevigo, Boehringer Ingelheim) is the first targeted treatment for GPP. NICE estimates that 1300 people could benefit.
The drug is an interleukin (IL) inhibitor given by intravenous infusion, usually once or twice per flare. The monoclonal antibody binds to interleukin 36 (IL-36) receptors, preventing the binding of IL-36 and the activation of proinflammatory pathways.
GPP is a rare and severe form of psoriasis. There is no licensed standard care for GPP flares. Current treatment options include ciclosporin, acitretin, and biologics used for other psoriasis types.
NICE said spesolimab could be used to treat GPP flares in adults, but only under specific clinical criteria. These include:
- A GPP Physician Global Assessment (GPPGA) total score of 3 or higher.
- Presence of fresh pustules or worsening of existing pustules.
- A GPPGA pustulation subscore of 2 or more.
- At least 5% of body surface area covered with erythema and the presence of pustules.
In final draft guidance, spesolimab was also recommended for subsequent flares if the previous flare was treated with the drug and resolved to a pustulation subscore of 0 or 1 (clear or almost clear skin).
Clinical evidence from the Effisayil 1 trial showed that spesolimab resolved moderate to severe GPP flares in adults faster than placebo. More patients treated with spesolimab achieved clear or almost clear skin.
Atezolizumab for Early-stage NSCLC
NICE has also recommended atezolizumab (Tecentriq, Roche) for the adjuvant treatment of NSCLC after surgery and chemotherapy.
Up to 560 people could be eligible for the treatment.
Atezolizumab is a humanised IgG monoclonal antibody which directly and selectively binds to programmed death-ligand 1 (PD-L1) on the surface of both tumour cells and tumour-infiltrating immune cells. Inhibiting PD-L1 enables T cells to recognise and attack tumour cells.
The drug can be given by infusion in hospital but can also be administered at home by injection. NICE said that home treatment could reduce hospital visits and improve patient quality of life.
In its final draft guidance, NICE said that atezolizumab can be used when:
- The patient has undergone complete tumour resection.
- They have received platinum-based chemotherapy.
- PD-L1 is expressed in 50% or more of tumour cells.
- The cancer is not EGFR-mutant or ALK-positive.
The recommendation is based on evidence from the IMpower010 trial. The study showed that atezolizumab significantly improved disease-free survival compared with best supportive care.
Lung cancer is the third most common type of cancer in the UK, accounting for 13% of all new cancer diagnoses.
There are around 49,229 new cases each year. More than 90% of lung cancer cases diagnosed in England are NSCLC.
Dr Rob Hicks is a retired NHS doctor. A well-known TV and radio broadcaster, he has written several books and has regularly contributed to national newspapers, magazines, and online. He is based in the UK.
