1 Recommendations
1.1 Amivantamab is not recommended, within its marketing authorisation, for treating locally advanced or metastatic non-small-cell lung cancer (NSCLC) after platinum-based chemotherapy in adults whose tumours have epidermal growth factor receptor (EGFR) exon 20 insertion mutations.
1.2 This recommendation is not intended to affect treatment with amivantamab 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
Current treatment for locally advanced or metastatic NSCLC with EGFR exon 20 insertion mutations after platinum-based chemotherapy can include platinum-based chemotherapy again, immunotherapies, and docetaxel with or without nintedanib.
Indirect comparisons using real-world evidence on immunotherapies, platinum-based chemotherapy, and docetaxel with or without nintedanib, suggest that amivantamab increases how long people live, and how long they have before their cancer gets worse. But this is uncertain because there is no direct comparison, and because of the way the real-world evidence was chosen and presented. So, the cost-effectiveness estimates are also uncertain.
Amivantamab meets NICE's criteria to be considered a life-extending treatment at the end of life. But, even taking this into account, the most plausible cost-effectiveness estimates are higher than what NICE usually considers an acceptable use of NHS resources. So, amivantamab is not recommended for routine use. Collecting more data would not resolve the uncertainties, so it is not recommended for use in the Cancer Drugs Fund.