1 Recommendations
1.1
Selpercatinib is recommended as an option in people 12 years and over for treating:
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advanced RET fusion-positive thyroid cancer that is refractory to radioactive iodine (if radioactive iodine is appropriate), only if systemic treatment is needed after sorafenib or lenvatinib
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advanced RET-mutant medullary thyroid cancer, only if systemic treatment is needed after cabozantinib or vandetanib.
Selpercatinib is only recommended if the company provides it according to the commercial arrangement.
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 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. For children or young people, this decision should be made jointly by the healthcare professional, the child or young person, and their parents or carers.
Why these recommendations were made:
This evaluation reviews the evidence for selpercatinib for treating advanced thyroid cancer with RET alterations (NICE technology appraisal guidance 742). It also reviews new data collected as part of the managed access agreement. The new evidence includes data from clinical trials and from people having treatment in the NHS in England.
This evaluation focuses on RET-mutant medullary thyroid cancer and RET fusion‑positive thyroid cancer (thyroid cancer with RET alterations) after it has been treated with a targeted cancer drug (sorafenib, lenvatinib, cabozantinib or vandetanib).
Usual treatment for thyroid cancer with RET alterations that has been treated with a targeted cancer drug is best supportive care.
Clinical evidence suggests that people having selpercatinib have longer before their cancer gets worse, and live longer, than people having best supportive care. But selpercatinib was not directly compared with best supportive care, so these results are uncertain.
But when considering the condition's severity, and its effect on quality and length of life, the most likely cost-effectiveness estimates are within what NICE considers an acceptable use of NHS resources. So, selpercatinib is recommended.
For all evidence see the committee papers.