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Draft guidance consultation

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1 Recommendations

1.1

Ripretinib should not be used for treating advanced gastrointestinal stromal tumour (GIST) in adults after 3 or more kinase inhibitors, including imatinib.

1.2

This recommendation is not intended to affect treatment with ripretinib 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

Ripretinib 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 ripretinib is value for money in this population.

Why the committee made these recommendations

Usual treatment for advanced GIST, after people have tried the tyrosine kinase inhibitors imatinib, sunitinib and regorafenib, is best supportive care.

Clinical trial evidence shows that ripretinib plus best supportive care increases the time before the cancer gets worse and increases how long people live compared with placebo plus best supportive care.

But there are uncertainties with the economic model. These include how it adjusted for people in the trial having ripretinib twice daily and how long people are expected to live in the long term.

Even when considering the condition's severity, the most likely cost-effectiveness estimates were above the range that NICE considers an acceptable use of NHS resources. So ripretinib should not be used.