Selpercatinib is recommended as an option for treating RET fusion-positive advanced non-small-cell lung cancer (NSCLC) that has not been treated with a RET inhibitor in adults, only if:
it has been treated before and
the company provides selpercatinib according to the commercial arrangement.
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 healthcare professional consider it appropriate to stop.
This evaluation reviews the evidence for selpercatinib for RET fusion-positive advanced NSCLC that has been treated but not with a RET inhibitor (NICE technology appraisal guidance 760). This does not include everyone who selpercatinib is licensed for. This evaluation also reviews new data collected as part of the managed access agreement. The new evidence includes data from clinical trials and from people having treatment in the NHS in England.
Usual treatment for previously treated, RET fusion-positive advanced NSCLC is docetaxel (a chemotherapy drug). Some people have docetaxel plus nintedanib (a targeted cancer drug). Selpercatinib is a RET inhibitor (a drug that targets RET fusion-positive cancer).
There are no clinical trials directly comparing selpercatinib with docetaxel or docetaxel plus nintedanib. But indirect comparisons with these treatments suggest selpercatinib may increase how long people have before their condition gets worse and how long they live for.
When considering the condition's severity, and its effect on quality and length of life, the most likely cost-effectiveness estimates are within what NICE considers an acceptable use of NHS resources. So, selpercatinib is recommended.