Dostarlimab with platinum-based chemotherapy is recommended with managed access as an option for treating primary advanced or recurrent endometrial cancer with high microsatellite instability or mismatch repair deficiency in adults who are candidates for systemic therapy. It is only recommended if the conditions in the managed access agreement for dostarlimab are followed.
This recommendation is not intended to affect treatment with dostarlimab with platinum-based chemotherapy 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
Usual treatment for primary advanced or recurrent endometrial cancer with high microsatellite instability or mismatch repair deficiency is platinum-based chemotherapy. The prognosis is poor for people with this condition, and there is an unmet need for more effective treatments.
Clinical trial evidence shows that adding dostarlimab to usual treatment increases how long people have before their condition gets worse. Evidence suggests it also increases how long they live, but the long-term benefits are uncertain because the study only followed people for a short period of time.
Because of the uncertainty in the clinical effectiveness evidence, there are uncertainties in the economic model. Some of the most likely cost-effectiveness estimates are higher than what NICE usually considers an acceptable use of NHS resources. This means dostarlimab with platinum-based chemotherapy cannot be recommended for routine use in the NHS.
Dostarlimab has the potential to be cost effective but more long-term evidence is needed to address the clinical uncertainties. So, dostarlimab is recommended for use with managed access.