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Selpercatinib for RET fusion-positive advanced non-small-cell lung cancer

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1 Recommendations

1.1 Selpercatinib is not recommended, within its marketing authorisation, for treating RET fusion-positive advanced non-small-cell lung cancer (NSCLC) in adults who need systemic therapy after immunotherapy or platinum-based chemotherapy.

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 clinician consider it appropriate to stop.

Why the committee made these recommendations

People with RET fusion-positive advanced NSCLC are usually offered docetaxel alone or docetaxel with nintedanib if they need systemic therapy after previous treatment.

Clinical trial evidence suggests some benefit for selpercatinib, but this is highly uncertain because it has not been compared with another treatment. Also, the trial has not been running long enough. Selpercatinib has been compared indirectly with other treatments but the results from this are also highly uncertain.

Cost-effectiveness estimates for selpercatinib compared with other treatments are not robust, and are much higher than what NICE normally considers an acceptable use of NHS resources. Selpercatinib does not meet NICE's end of life or Cancer Drugs Fund criteria because of the lack of robust cost-effectiveness estimates. Therefore, selpercatinib cannot be recommended as a cost-effective use of NHS resources.