1.1 Vandetanib is not recommended, within its marketing authorisation, for treating aggressive and symptomatic medullary thyroid cancer in adults with unresectable, locally advanced or metastatic disease.
1.2 This recommendation is not intended to affect treatment with vandetanib 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 clinician consider it appropriate to stop.
Why the committee made these recommendations
Vandetanib and cabozantinib are the only systemic treatment options for unresectable, locally advanced or metastatic medullary thyroid cancer. Best supportive care is the only other available option for people who cannot have vandetanib or cabozantinib.
Clinical trial evidence suggests that vandetanib may delay disease progression compared with best supportive care, but the benefit is uncertain. The evidence about whether vandetanib increases the overall length of time people live is unreliable. Clinical experts consider that vandetanib and cabozantinib are similarly effective, so more robust data from a cabozantinib trial are used because of the uncertainties in the evidence.
Cost-effectiveness estimates for vandetanib compared with either best supportive care or cabozantinib are much higher than what NICE normally considers an acceptable use of NHS resources. Vandetanib does not meet NICE's end-of-life or Cancer Drugs Fund criteria. Therefore, it cannot be recommended as a cost-effective use of NHS resources.