1 Recommendations

1.1 Selpercatinib is recommended for use within the Cancer Drugs Fund as an option for treating RET fusion-positive advanced non-small-cell lung cancer (NSCLC) in adults who need systemic therapy after immunotherapy, platinum-based chemotherapy or both. It is recommended only if the conditions in the managed access agreement are followed.

1.2 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 clinician consider it appropriate to stop.

Why the committee made these recommendations

People with RET fusion-positive advanced NSCLC are usually offered docetaxel if they need systemic therapy after previous treatment. Sometimes they may be offered docetaxel with nintedanib.

Clinical trial evidence suggests some benefit for selpercatinib, but this is highly uncertain because the trial has not been running long enough. Also, selpercatinib is not directly compared with another treatment in the trial. It is compared indirectly with other treatments, but the results from this are also highly uncertain. Because of this, the estimates of cost effectiveness are very uncertain and selpercatinib cannot be recommended for routine use in the NHS.

Selpercatinib could be cost effective if further data shows that people live longer with treatment. Data from the trial of selpercatinib and from NHS practice would help address the uncertainty about clinical effectiveness. Selpercatinib is therefore recommended for use in the Cancer Drugs Fund.

  • National Institute for Health and Care Excellence (NICE)