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Draft guidance consultation

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1 Recommendations

1.1

Selpercatinib is not recommended for:

  • advanced RET-mutant medullary thyroid cancer that has not been treated with systemic therapy in people 12 years and older

  • advanced RET fusion-positive thyroid cancer that has not been treated with systemic therapy, and is refractory to or not suitable for radioactive iodine in people 12 years and older.

1.2

This recommendation is not intended to affect treatment with selpercatinib 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. For young people, this decision should be made jointly by the clinician, the young person, and their parents or carers.

Why the committee made these recommendations

This evaluation considered selpercatinib for thyroid cancer that has not been treated with systemic therapy. NICE has already evaluated selpercatinib for thyroid cancer that has been treated with systemic therapy (see NICE technology appraisal guidance 742).

Usual treatment for RET-mutant medullary thyroid cancer that has not been treated with systemic therapy is cabozantinib or best supportive care (BSC, which includes routine care and monitoring). For RET fusion-positive thyroid cancer that has not been treated with systemic therapy, and is refractory to or not suitable for radioactive iodine, usual treatment is sorafenib, lenvatinib or BSC.

The main clinical trial did not directly compare selpercatinib with usual treatment. Indirect comparisons suggest that people having selpercatinib live for longer and have longer before their cancer gets worse than people having usual treatment. But this is uncertain.

There were no cost-effectiveness estimates that compared selpercatinib with sorafenib. All of the cost-effectiveness estimates that compared selpercatinib with the other usual treatments are above what NICE considers an acceptable use of NHS resources. So selpercatinib is not recommended.