Ripretinib can be used, within its marketing authorisation, as an option to treat advanced gastrointestinal stromal tumours (GISTs) in adults after 3 or more kinase inhibitors, including imatinib. Ripretinib can only be used if the company provides it according to the commercial arrangement.
Ripretinib must be funded in the NHS in England for the condition and population in the recommendation, if it is considered the most suitable treatment option. Ripretinib must be funded in England within 90 days of final publication of this guidance.
There is enough evidence to show that ripretinib provides benefits and value for money, so it can be used routinely across the NHS in this population.
NICE has produced tools and resources to support the implementation of this guidance.
Usual treatment for advanced GISTs, after the tyrosine kinase inhibitors imatinib, sunitinib and regorafenib, is best supportive care.
Clinical trial evidence shows that ripretinib plus best supportive care increases how long people have before their cancer gets worse and how long they live compared with placebo plus best supportive care.
There are uncertainties in the economic model, including:
how it adjusted for people in the trial who had a higher dosage of ripretinib than they would have in the NHS
a lack of evidence on how long people are likely to live, especially after stopping ripretinib.
But when considering the condition's severity, the most likely cost-effectiveness estimates are within the range that NICE considers an acceptable use of NHS resources. So, ripretinib can be used.