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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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    Are the recommendations sound and a suitable basis for guidance to the NHS?

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Draft guidance consultation

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1 Recommendations

1.1

Tarlatamab is not recommended, within its marketing authorisation, for treating extensive-stage small-cell lung cancer in adults whose cancer has progressed after 2 or more lines of treatment, including platinum-based chemotherapy.

1.2

This recommendation is not intended to affect treatment with tarlatamab 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 healthcare professional consider it appropriate to stop.

Why the committee made these recommendations

There are no approved treatments for extensive-stage small-cell lung cancer that has progressed after 2 or more lines of treatment, including platinum-based chemotherapy. So, people usually have chemotherapy again or best supportive care.

Clinical trial evidence suggests that tarlatamab increases how long people have before their cancer gets worse and how long they live. But, the extent of this benefit is uncertain because the trial did not compare tarlatamab with chemotherapy. It has been indirectly compared with chemotherapy but the results are uncertain.

Because of the uncertainties in the clinical evidence, the cost-effectiveness estimates are also uncertain. All the cost-effectiveness estimates are above the range that NICE considers an acceptable use of NHS resources. So, tarlatamab is not recommended.

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