The selective internal radiation therapy (SIRT) QuiremSpheres is recommended as an option for treating unresectable advanced hepatocellular carcinoma (HCC) in adults, only if it is:
used for people with Child–Pugh grade A liver impairment when conventional transarterial therapies are inappropriate, and
the company provides it according to the commercial arrangement.
This recommendation is not intended to affect treatment with QuiremSpheres 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.
Why these recommendations were made
This evaluation is a partial review of NICE's technology appraisal guidance on selective internal radiation therapies for treating hepatocellular carcinoma (TA688). This evaluation reviews new evidence submitted by the company.
Treatment depends on the stage of HCC and liver function. Treatment options include surgery, transarterial therapies (including SIRT with SIR‑Spheres and TheraSphere), chemotherapy and best supportive care. Treatment does not cure HCC for most people. QuiremSpheres is another treatment option that could be used instead of SIR‑Spheres and TheraSphere.
Clinical trial evidence for QuiremSpheres is limited. It has not been directly compared with SIR‑Spheres and TheraSphere. But the results from an indirect comparison suggest that it is as effective as SIR-Spheres and TheraSphere.
A cost comparison suggests QuiremSpheres has similar costs to SIR‑Spheres and TheraSphere. So, QuiremSpheres is recommended.
For all evidence see the committee papers. To see what NICE did for SIR‑Spheres and TheraSphere, see the committee discussion section in NICE's technology appraisal guidance on selective internal radiation therapies for treating hepatocellular carcinoma.