The application of the National Institute of Clinical Excellence guidelines for treatment of metastatic renal cell carcinoma in the United Kingdom: friend or foe?

摘要

Targeted therapy has replaced immunotherapy as standard treatment in metastatie renal cell carcinoma (mRCC). Both first- and second-line targeted therapy is associated with clinical benefit in this setting. The National Institute of Clinical Excellence (NICE) focuses on the cost of drugs as well as their efficacy. It does this by calculation of the cost per quality adjusted life year (QALY) of an agent. NICE has recently assessed targeted therapy in RCC and approved sunitinib in isolation in the first-line metastatic setting, while rejecting other first- and second-line agents. Several clinical issues have arisen from this decision, including when to commence and discontinue therapy and how to treat patients who are not eligible for sunitinib. These issues, which are likely to become more prevalent in the era of healthcare economics, are addressed in this article.