# Lung cancer drugs in England: what NICE has recommended

Source: https://onco.cc/terms/lung-uk-drug-access/  
OnCo record `lung-uk-drug-access` (Term). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Which lung cancer drugs the NHS in England funds, and which it does not. Every reference number below was opened on the NICE website in September 2026 and its recommendation read.

## Summary

Early disease. Osimertinib is recommended after complete resection of stage IB to IIIA EGFR-mutant disease, stopped at three years (TA1043, 26 February 2025). Pembrolizumab is recommended as adjuvant treatment of resected disease at high risk of recurrence after platinum chemotherapy (TA1037, 5 February 2025), and atezolizumab in the same setting only where PD-L1 is on 50 percent or more of tumour cells and the tumour is not EGFR-mutant or ALK-positive (TA1071, 19 June 2025). Three perioperative regimens are funded and NICE asks that the least expensive suitable one is used: nivolumab with chemotherapy before surgery then alone after it (TA1127, 4 February 2026), pembrolizumab in the same schedule (TA1017, 20 November 2024) and durvalumab in the same schedule (TA1030, 15 January 2025); neoadjuvant nivolumab with chemotherapy alone is covered by the earlier TA876 (22 March 2023).

Stage III. Durvalumab after concurrent platinum-based chemoradiation is recommended where PD-L1 is on 1 percent or more of cells (TA798, 22 June 2022), a restriction the licence does not carry. For EGFR-mutant stage III disease that has not progressed after chemoradiotherapy, osimertinib is recommended (TA1156, 21 May 2026).

EGFR-mutant metastatic disease. Osimertinib alone (TA654, 14 October 2020), osimertinib with pemetrexed and platinum chemotherapy (TA1060, 8 May 2025), amivantamab with lazertinib (TA1122, 21 January 2026) and dacomitinib (TA595, 14 August 2019) are all recommended first line; osimertinib is also recommended after progression on an earlier EGFR inhibitor where T790M is present (TA653, 14 October 2020). For exon 20 insertions, amivantamab with carboplatin and pemetrexed is available during a managed access period first line (TA1158, 28 May 2026), but amivantamab after platinum chemotherapy is not recommended (TA850, 14 December 2022).

ALK-positive disease. Lorlatinib (TA1103, 21 October 2025), brigatinib (TA670, 27 January 2021), alectinib (TA536, 8 August 2018) and ceritinib (TA500, 24 January 2018) are all recommended for untreated disease; after an earlier ALK inhibitor, lorlatinib (TA628, 13 May 2020) and brigatinib after crizotinib (TA571, 20 March 2019) are recommended.

Other drivers. Crizotinib (TA1021, 4 December 2024) and entrectinib (TA643, 12 August 2020) are recommended for ROS1-positive disease, with NICE asking for the least expensive. Sotorasib is recommended only through the Cancer Drugs Fund for previously treated KRAS G12C disease (TA781, 30 March 2022). Selpercatinib is recommended with managed access for untreated RET fusion-positive disease (TA911, 26 July 2023) and routinely after previous treatment (TA1042, 19 February 2025); pralsetinib is not recommended (TA812, 3 August 2022). Tepotinib is recommended for MET exon 14 skipping disease (TA789, 18 May 2022). For BRAF V600E disease, dabrafenib with trametinib (TA898, 14 June 2023) and encorafenib with binimetinib (TA1150, 6 May 2026) are each recommended first line only.

Immunotherapy without a driver. First line: pembrolizumab alone at a tumour proportion score of 50 percent or more, stopped at two years (TA531, 18 July 2018); pembrolizumab with pemetrexed and platinum for non-squamous disease (TA683, 10 March 2021); pembrolizumab with carboplatin and paclitaxel for squamous disease (TA770, 9 February 2022); atezolizumab alone where PD-L1 is on at least 50 percent of tumour cells or 10 percent of immune cells (TA705, 2 June 2021); atezolizumab with bevacizumab, carboplatin and paclitaxel for non-squamous disease at a tumour proportion score of 0 to 49 percent or after targeted therapy (TA584, 5 June 2019); and cemiplimab with platinum chemotherapy where pembrolizumab would otherwise be offered (TA1165, 16 June 2026). Nivolumab with ipilimumab and two cycles of chemotherapy is not recommended (TA724, 8 September 2021). After chemotherapy: pembrolizumab where PD-L1 is positive (TA428, 11 January 2017, updated 12 September 2017), atezolizumab (TA520, 16 May 2018), nivolumab for squamous disease (TA655, 21 October 2020) and for PD-L1-positive non-squamous disease (TA713, 7 July 2021), each stopped at two years; nintedanib with docetaxel for adenocarcinoma after first-line chemotherapy (TA347, 22 July 2015). Ramucirumab with docetaxel is not recommended (TA403, 24 August 2016).

Small-cell lung cancer. Atezolizumab with carboplatin and etoposide (TA638, 1 July 2020), durvalumab with etoposide and carboplatin or cisplatin (TA1041, 19 February 2025) and serplulimab with carboplatin and etoposide (TA1167, 18 June 2026) are each recommended for untreated extensive-stage disease, the first two only at performance status 0 or 1. Durvalumab is recommended for limited-stage disease that has not progressed after platinum-based chemoradiotherapy (TA1099, 1 October 2025). Oral topotecan is recommended for relapsed disease only where re-treatment with the first-line regimen is inappropriate and CAV is contraindicated (TA184, 25 November 2009). Tarlatamab is not recommended (TA1091, 20 August 2025). Lurbinectedin has no NICE appraisal and no United Kingdom marketing authorisation.

The clinical guideline for the whole pathway is NG122 (28 March 2019, last updated 8 March 2024).

## Fields

- Kind: Term
- Last checked: 2026-09-25
- Also known as: NICE lung cancer guidance; Lung cancer drug funding England

## Sources

- NICE NG122: lung cancer, diagnosis and management: https://www.nice.org.uk/guidance/ng122
- NICE TA1043: osimertinib for adjuvant treatment after complete tumour resection: https://www.nice.org.uk/guidance/ta1043
- NICE TA1127: nivolumab with chemotherapy, neoadjuvant then adjuvant, for resectable non-small-cell lung cancer: https://www.nice.org.uk/guidance/ta1127
- NICE TA1103: lorlatinib for untreated ALK-positive advanced non-small-cell lung cancer: https://www.nice.org.uk/guidance/ta1103
- NICE TA1099: durvalumab for limited-stage small-cell lung cancer after platinum-based chemoradiotherapy: https://www.nice.org.uk/guidance/ta1099

## Connected records

- cancers: [Lung cancer (all types)](https://onco.cc/cancers/lung-cancer/), [Non-small-cell lung cancer](https://onco.cc/cancers/nsclc/), [Small-cell lung cancer](https://onco.cc/cancers/sclc/)
- drugs: [Alectinib](https://onco.cc/drugs/alectinib/), [Amivantamab](https://onco.cc/drugs/amivantamab/), [Atezolizumab](https://onco.cc/drugs/atezolizumab/), [Brigatinib](https://onco.cc/drugs/brigatinib/), [Cemiplimab](https://onco.cc/drugs/cemiplimab/), [Ceritinib](https://onco.cc/drugs/ceritinib/), [Crizotinib](https://onco.cc/drugs/crizotinib/), [Dabrafenib + trametinib](https://onco.cc/drugs/dabrafenib-trametinib/), [Dacomitinib](https://onco.cc/drugs/dacomitinib/), [Durvalumab](https://onco.cc/drugs/durvalumab/), [Entrectinib](https://onco.cc/drugs/entrectinib/), [Ipilimumab](https://onco.cc/drugs/ipilimumab/), [Lazertinib](https://onco.cc/drugs/lazertinib/), [Lorlatinib](https://onco.cc/drugs/lorlatinib/), [Lurbinectedin](https://onco.cc/drugs/lurbinectedin/), [Nintedanib](https://onco.cc/drugs/nintedanib/), [Nivolumab](https://onco.cc/drugs/nivolumab/), [Osimertinib](https://onco.cc/drugs/osimertinib/), [Pembrolizumab](https://onco.cc/drugs/pembrolizumab/), [Pralsetinib](https://onco.cc/drugs/pralsetinib/), [Ramucirumab](https://onco.cc/drugs/ramucirumab/), [Selpercatinib](https://onco.cc/drugs/selpercatinib/), [Serplulimab](https://onco.cc/drugs/serplulimab/), [Sotorasib](https://onco.cc/drugs/sotorasib/), [Tarlatamab](https://onco.cc/drugs/tarlatamab/), [Tepotinib](https://onco.cc/drugs/tepotinib/), [Topotecan](https://onco.cc/drugs/topotecan/)
- terms: [Cancer Drugs Fund (England)](https://onco.cc/terms/cancer-drugs-fund/)

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