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Cabozantinib for treating advanced neuroendocrine tumours that have progressed after systemic treatment

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1 Recommendations

1.1

Cabozantinib should not be used to treat unresectable or metastatic well-differentiated extra-pancreatic neuroendocrine tumours (epNET) and pancreatic neuroendocrine tumours (pNET) that have progressed after at least 1 systemic treatment other than somatostatin analogues (SSAs).

1.2

This recommendation is not intended to affect treatment with cabozantinib 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.

What this means in practice

Cabozantinib is not required to be funded and should not be used routinely in the NHS in England for the condition and population in the recommendations.

This is because the available evidence does not suggest that cabozantinib is value for money in this population.

Why the committee made these recommendations

Unresectable or metastatic well-differentiated epNETs and pNETs are usually treated with SSAs, which are systemic treatments. After this, other systemic treatments can be used, including everolimus, sunitinib and peptide receptor radionuclide therapy (PRRT). After systemic treatments, best supportive care is the only treatment option.

The company asked for cabozantinib to be considered in a population for whom best supportive care is the only treatment option, to reflect the population in the clinical trial. This evidence does not include everyone cabozantinib is licensed for.

Evidence from a clinical trial shows that, compared with placebo, cabozantinib increases how long people have before their condition gets worse. But it is not clear whether people live longer if they have cabozantinib.

There are also uncertainties in the economic evidence. This is because of the way the economic model:

  • predicts long-term survival

  • includes treatments used at the same time and after cabozantinib.

Because of the uncertainties in the economic and clinical evidence, it is not possible to determine the most likely cost-effectiveness estimates for cabozantinib. So, it should not be used.