Cabozantinib for treating medullary thyroid cancer

1.1 Cabozantinib is recommended, within its marketing authorisation, as an option for treating progressive medullary thyroid cancer in adults with unresectable, locally advanced or metastatic disease, only if the company provides cabozantinib with the discount agreed in the patient access scheme.

Why the committee made these recommendations

Cabozantinib and vandetanib are the only systemic treatment options for unresectable, locally advanced or metastatic medullary thyroid cancer. Both drugs are currently available through the Cancer Drugs Fund for progressive and symptomatic disease. Best supportive care is the only other available option for people who cannot have cabozantinib or vandetanib.

Clinical trial evidence suggests that cabozantinib is effective in delaying disease progression compared with best supportive care, but may not prolong survival. Without reliable comparative data, it was considered that cabozantinib and vandetanib are likely to be similarly effective.

The cost-effectiveness estimates for cabozantinib compared with best supportive care and vandetanib are less than £30,000 per quality-adjusted life year gained. Therefore, cabozantinib can be recommended as a cost-effective use of NHS resources.