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Vorasidenib for treating astrocytoma or oligodendroglioma with IDH1 or IDH2 mutations after surgery in people 12 years and over

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1 Recommendations

1.1

Vorasidenib should not be used to treat grade 2 astrocytoma or oligodendroglioma with a susceptible isocitrate dehydrogenase (IDH) 1 or IDH2 mutation in people 12 years and over who do not need immediate chemotherapy or radiotherapy after surgery.

1.2

This recommendation is not intended to affect treatment with vorasidenib 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. For young people, this decision should be made jointly by the healthcare professional, the young person, and their parents or carers.

What this means in practice

Vorasidenib 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 vorasidenib is value for money in this population.

Why the committee made these recommendations

Usual care for astrocytoma or oligodendroglioma with IDH1 or IDH2 mutations for people who do not need immediate chemotherapy or radiotherapy after surgery is active surveillance.

Clinical trial evidence shows that vorasidenib increases how long people have before their cancer gets worse compared with placebo. But it is unclear if vorasidenib affects how long people with the condition live.

There are uncertainties in the economic model, including assumptions on:

  • how long people who had vorasidenib or placebo wait before starting a new treatment after their cancer gets worse

  • if vorasidenib extends how long people live

  • the quality of life of people in the model.

Because of the uncertainties in the economic model it is not possible to determine the most likely cost-effectiveness estimates for vorasidenib. So, vorasidenib should not be used routinely in the NHS.

Collecting more evidence during a managed access period is unlikely to resolve the key uncertainties in the evidence. So, vorasidenib cannot be used with managed access.