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    Has all of the relevant evidence been taken into account?

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    Are the summaries of clinical and and cost effectiveness reasonable interpretations of the evidence?

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Draft guidance consultation

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1 Recommendations

1.1 Cabozantinib is not recommended, within its marketing authorisation, for treating locally advanced or metastatic differentiated thyroid cancer (DTC) that is unsuitable for or refractory to radioactive iodine, and that has progressed after systemic treatment, in adults.

1.2 This recommendation is not intended to affect treatment with cabozantinib 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 treatment for advanced DTC that is unsuitable for, or does not respond (refractory) to, radioactive iodine, and that has got worse after systemic treatment, is best supportive care.

Clinical trial evidence shows that, compared with best supportive care, cabozantinib increases how long people have before their condition gets worse. But it is not clear if it increases how long people live. This is because people were not followed up for long enough, and because of how the trial was done.

Because it is not clear if cabozantinib increases how long people live, the most likely cost-effectiveness estimates are not clear. Because of this, they would need to be towards the lower end of the range that NICE considers an acceptable use of NHS resources. But the most likely cost-effectiveness estimates are towards the higher end of the range that NICE considers an acceptable use of NHS resources. This is true even when considering the condition's severity, and its effect on quality and length of life.

More evidence could help address the uncertainty about the benefits of cabozantinib, but the company said that there would be no more evidence from the trial. So, cabozantinib is not recommended.