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Durvalumab with platinum-based chemotherapy, then with or without olaparib, for untreated advanced or recurrent endometrial cancer

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1 Recommendations

1.1

Durvalumab with platinum-based chemotherapy, then maintenance durvalumab monotherapy, can be used as an option for untreated primary advanced or recurrent endometrial cancer that is mismatch repair deficient (dMMR) in adults who can have systemic treatment.

It should be stopped after 3 years, or earlier if there is disease progression or unacceptable toxicity.

Durvalumab with platinum-based chemotherapy, then maintenance durvalumab monotherapy, can be used if the company provides it according to the commercial arrangement (see section 2).

1.2

Durvalumab with platinum-based chemotherapy, then maintenance durvalumab plus olaparib, should not be used for untreated primary advanced or recurrent endometrial cancer that is mismatch repair proficient (pMMR) in adults who can have systemic treatment.

1.3

These recommendations are not intended to affect treatment with durvalumab with platinum-based chemotherapy, then with or without olaparib, that was started in the NHS before this guidance was published. People having treatment outside these recommendations 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.

What this means in practice

dMMR endometrial cancer

Durvalumab with platinum-based chemotherapy, then maintenance durvalumab monotherapy, must be funded in the NHS in England for untreated primary advanced or recurrent endometrial cancer that is dMMR in adults who can have systemic treatment, if it is considered the most suitable treatment option. Durvalumab with platinum-based chemotherapy, then maintenance durvalumab monotherapy, must be funded in England within 90 days of final publication of this guidance.

There is enough evidence to show that durvalumab with platinum-based chemotherapy, then maintenance durvalumab monotherapy provides benefits and value for money in adults whose cancer is dMMR, so it can be used routinely across the NHS.

pMMR endometrial cancer

Durvalumab with platinum-based chemotherapy, then maintenance durvalumab plus olaparib, is not required to be funded in the NHS in England for untreated primary advanced or recurrent endometrial cancer that is pMMR in adults who can have systemic treatment. It should not be used routinely in the NHS in England.

This is because the available evidence does not suggest that durvalumab with platinum-based chemotherapy, then maintenance durvalumab plus olaparib, offers value for money in adults whose cancer is pMMR.

Why the committee made these recommendations

Usual treatment for untreated advanced or recurrent endometrial cancer is platinum-based chemotherapy (from here just chemotherapy) then routine surveillance. This evaluation looked at dMMR and pMMR subpopulations.

For the dMMR subgroup, clinical trial evidence shows that durvalumab with chemotherapy and then maintenance durvalumab alone gives people with endometrial cancer longer before their condition gets worse than just chemotherapy then routine surveillance. Evidence suggests that it also increases how long people live, but the long-term benefits are uncertain because the study is ongoing and has only followed people for a short time.

In the dMMR subgroup, the cost-effectiveness estimates are within the range that NICE considers an acceptable use of NHS resources. So durvalumab with chemotherapy then maintenance durvalumab alone can be used in this group.

In this subgroup, durvalumab should be stopped after 3 years, or earlier if the condition gets worse or there are unacceptable side effects. This reflects how other immunotherapies like durvalumab are used in clinical practice, and how clinical experts said they would use durvalumab.

In the pMMR subgroup, clinical trial evidence shows that durvalumab with chemotherapy then maintenance durvalumab plus olaparib gives people with endometrial cancer longer before their condition gets worse than just chemotherapy then routine surveillance. Evidence suggests that it may also increase how long people live, but the long-term benefits are uncertain because the study is ongoing and has only followed people for a short time.

In the pMMR subgroup, the cost-effectiveness estimates are substantially above the range that NICE considers an acceptable use of NHS resources. So durvalumab with platinum-based chemotherapy then maintenance durvalumab plus olaparib should not be used in this subgroup.

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