Review Decision – March 2016

Review of NICE Technology Appraisal Guidance No.23; Temozolomide for the treatment of recurrent malignant glioma, and No.121; Carmustine implants and temozolomide for the treatment of newly diagnosed high grade glioma

Decision to move the existing guidance to the ‘static guidance’ list – March 2016

The Institute was proposing that TA121 should be moved to the ‘static guidance’ list, and that TA23 should be re-issued and moved to the ‘static guidance’ list.

After consideration of all of the comments received during the Review Consultation, the Technology Appraisals programme has decided to proceed with this proposal.

TA121 will therefore move to the ‘static guidance’ list. TA23 will be re-issued, and the re-issued guidance will be moved to the ‘static guidance’ list.

Topics on the static list may be transferred back to the active list for further appraisal if new evidence becomes available that is likely to have a material effect on the last guidance issued.

Details on the re-issuing of TA23

Recommendation 1.1 of TA23 should be changed to reflect current conventions and the guidance should be transferred to the ‘static guidance list’.

The existing recommendations 1.2 and 1.3 should be withdrawn because they were superseded by TA121, which considered the use of temozolomide in newly-diagnosed malignant glioma.

 The updated wording for TA23 will read as follows: 

  • Temozolomide is recommended as an option for treating malignant glioma, such as glioblastoma multiforme or anaplastic astrocytoma, showing recurrence or progression after standard therapy only if the patient has a Karnofsky performance status score greater than or equal to 70 and a projected life expectancy of 12 weeks or more. 
  • When using the Karnofsky performance status score, clinicians should be mindful aware of the need to secure equality of access to treatment for patients with disabilities. Clinicians should bear in mind that people with disabilities may have difficulties with activities of daily living that are unrelated to their prognosis with respect for malignant glioma. In such cases For such people clinicians should make appropriate judgements of about performance status, taking into account the person's usual functional capacity and requirement need for assistance with activities of daily living. 
  • This recommendation has been updated by recommendation 1.1 in the NICE technology appraisal guidance on carmustine implants and temozolomide for the treatment of newly diagnosed high-grade glioma. 
  • People whose treatment with temozolomide is not recommended in this NICE guidance, but was started within the NHS before this guidance was published, should be able to continue treatment until they and their NHS clinician consider it appropriate to stop.

Appendix A - RPP decision paper - March 2016

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