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Avapritinib for treating unresectable or metastatic gastrointestinal stromal tumours

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1 Recommendations

1.1 Avapritinib is not recommended, within its marketing authorisation, for treating unresectable or metastatic gastrointestinal stromal tumours (GIST) that have the platelet-derived growth factor receptor alpha (PDGFRA) D842V mutation in adults.

1.2 This recommendation is not intended to affect treatment with avapritinib that was started in the NHS before this guidance was published. People having treatment outside this recommendation may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS clinician consider it appropriate to stop.

Why the committee made these recommendations

People with unresectable or metastatic GIST with the PDGFRA D842V mutation usually have imatinib then best supportive care, or best supportive care only, in specialist sarcoma centres. This is referred to as established clinical management.

There is no direct evidence comparing avapritinib with established clinical management but indirect evidence suggests that people with GIST who have avapritinib may live longer, and also live longer before their disease gets worse.

Avapritinib meets NICE's criteria to be a life-extending treatment at the end of life. But, even taking that into account, the most plausible cost-effectiveness estimates are higher than the range normally considered a cost-effective use of NHS resources. So, avapritinib is not recommended.

Avapritinib does not meet the criteria to be included in the Cancer Drugs Fund because it does not have the potential to be cost effective at the price offered.