The UK National Institute for Health and Clinical Excellence (NICE) is recommending the use of sunitinib as a first line treatment for advanced kidney cancer, in draft guidance issued this week. The guidance comes after NICE applied new arrangements for assessing the cost effectiveness of drugs for people who are terminally ill, overturning its previous ruling that the drug did not offer the NHS value for money.

The latest draft guidance recommends sunitinib, an oral tyrosine kinase inhibitor, as a first line treatment option in advanced or metastatic renal cell carcinoma in patients who are suitable for immunotherapy and who are fit enough.

However, the guidance does not recommend the use of three other drugs—bevacizumab, sorafenib, and temsirolimus—for first line treatment for these patients. Furthermore, the two drugs that are also licensed for second line treatment, sorafenib and sunitinib, are not recommended by NICE for second line treatment.

The previous draft of the guidance acknowledged that sunitinib was a clinically effective treatment but considered that it did not offer a cost …