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Tepotinib for treating advanced non-small-cell lung cancer with MET gene alterations

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1 Recommendations

1.1 Tepotinib is not recommended, within its marketing authorisation, for treating advanced non-small-cell lung cancer (NSCLC) with MET exon 14 (METex14) skipping alterations in adults.

1.2 This recommendation is not intended to affect treatment with tepotinib 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

Standard care for advanced METex14 skipping NSCLC is usually immunotherapy plus platinum-doublet chemotherapy (chemo-immunotherapy). People have different treatments depending on their PD‑L1 tumour proportion score and whether they have squamous or non-squamous NSCLC.

Clinical trial evidence suggests a clinical benefit for tepotinib, but this is uncertain because tepotinib was not directly compared with another treatment. It has been indirectly compared with groups of other treatments, but the results of this are highly uncertain. This is particularly the case for the comparison with chemo-immunotherapy, the most widely used treatment.

The economic model is uncertain because it is unclear how much longer people having tepotinib live compared with those having standard care. There is also uncertainty around what treatments people would have after tepotinib and standard care.

Because of the problems with the company's model, it is not possible to confidently estimate tepotinib's cost effectiveness. Collecting more data in the Cancer Drugs Fund is unlikely to help to resolve the main uncertainty and tepotinib has not been reliably shown to have potential to be cost effective. So, tepotinib is not recommended for routine use or through the Cancer Drugs Fund.