Anti-PD1 and anti-PDL1 immunotherapy has transformed urothelial carcinoma treatment. Pembrolizumab is the only immunotherapy agent shown to have survival benefit compared with standard chemotherapy after progression on platinum-containing chemotherapy. Initial National Institute for Health and Care Excellence (NICE) approval was based on efficacy data, but the final appraisal report rejected use of pembrolizumab owing to treatment cost.
NICE’s rejection of pembrolizumab for platinum-refractory urothelial carcinoma: is there a greater good?