1 Recommendations
1.1
Selpercatinib is recommended as an option for treating:
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advanced RET fusion-positive thyroid cancer that is refractory to radioactive iodine (if radioactive iodine is appropriate)
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advanced RET-mutant medullary thyroid cancer.
It is for people 12 years and over and is recommended only if:
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the cancer has not been treated with a targeted cancer drug, and
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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 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. 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 the committee made these recommendations
This evaluation focuses on RET-mutant medullary thyroid cancer and RET fusion-positive thyroid cancer that has not been treated with a targeted cancer drug.
People may have surgery to remove all or part of the thyroid before starting drug treatments. Usual treatments for RET-mutant medullary thyroid cancer include cabozantinib (a targeted cancer drug) and best supportive care (routine care and monitoring). Usual treatments for RET fusion-positive thyroid cancer that is refractory to radioactive iodine include targeted cancer drugs (lenvatinib or sorafenib) and best supportive care. Selpercatinib is a targeted cancer drug.
The main clinical trial supporting this evaluation did not directly compare selpercatinib with usual treatment. Indirect comparisons suggest that people having selpercatinib have longer before their cancer gets worse and live longer than people having usual treatment. But this is uncertain.
The most likely cost-effectiveness estimates are below what NICE considers an acceptable use of NHS resources. So selpercatinib is recommended.