NICE has recommended pembrolizumab as an option for treating locally advanced or metastatic PD-L1-positive NSCLC in adults who have had at least one chemotherapy (and targeted treatment if they have an epidermal growth factor receptor- or anaplastic lymphoma kinase-positive tumour) on the proviso that the the drug is stopped at two years of uninterrupted treatment with no documented disease progression.
Pembrolizumab (Keytruda) is licensed for the indication approved in the NICE guidance and also for the treatment of advanced (unresectable or metastatic) melanoma in adults.
Pomalidomide, in combination with low-dose dexamethasone, has been approved as an option for treating multiple myeloma in adults at third or subsequent relapse, following three previous treatments including both lenalidomide and bortezomib.
The licensed indications for pomalidomide (Imnovid) differ from the NICE guidance in that it is indicated for use in adults with relapsed and refractory multiple myeloma who have received at least two prior treatment regimens, including both lenalidomide and bortezomib, and have demonstrated disease progression on the the last therapy. The guidance states that the 'evidence for pomalidomide with dexamethasone in this indication was largely for patients whose disease was heavily pre-treated, which was consistent with using it after 3 or more therapies'.
In both cases the company must provide the drug within the discount agreed in the patient access scheme. Treatment of patients already being treated with either drug may continue according to whatever funding arrangements were in place before the guidance was issued until they and their NHS clinician consider it appropriate to stop.