1 Recommendations

1.1 Cabozantinib is recommended as an option for treating advanced hepatocellular carcinoma (HCC) in adults who have had sorafenib, only if:

they have Child–Pugh grade A liver impairment and an Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1, and
the company provides it according to the commercial arrangement.

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

Current treatment for advanced HCC in adults who have had sorafenib is regorafenib. Cabozantinib is an alternative for these people.

Clinical trial evidence shows that cabozantinib is effective for treating advanced HCC compared with placebo. But cabozantinib has not been compared directly with regorafenib. The results of indirect comparisons suggest that cabozantinib is likely to be similarly effective to regorafenib, although this is not certain.

The most plausible cost-effectiveness estimates are within the range that NICE normally considers an acceptable use of NHS resources. Because of this, and because there are few treatment options for people with advanced HCC who have tried sorafenib, cabozantinib is recommended.