Review decision – December 2019

Decision to move the existing TA347, TA374, TA395, TA403, TA422 and TA428 guidance to the static list

We would like to update you on the decision made regarding the review of the existing guidance on TA347; Nintedanib, TA374; Erlotinib and gefitinib, TA395; Ceritinib, TA403; Ramucirumab, TA422; Crizotinib and TA428; Pembrolizumab.

No evidence has been identified which would lead to a change in the recommendations for TA347 and TA395. However, the position of these technologies in the lung cancer pathway has changed and requires context for use in clinical practice, therefore, TA347 and TA395 have been cross referenced in the update of NICE’s guideline CG121.

There has also been no evidence identified which would lead to a change in the recommendations for technology appraisals TA374, TA403 and TA422.

Ramucirumab and gefitinib are not recommended. The recommendations for TA374 and TA422 relate to patient populations that are small or diminishing in clinical practice. In addition, the evidence for TA422 is based on a population that is no longer seen in clinical practice. Therefore, it is considered appropriate to transfer the guidance to the static list without being cross referenced in NICE’s guideline CG121.

A review of the literature relating to TA428 (pembrolizumab) has identified emerging evidence that the current recommendations may include a cost-ineffective subgroup. A meta-analysis of evidence from clinical trials suggests that checkpoint inhibitors have similar efficacy to docetaxel for treating people who have previously had an EGFR-targeted therapy for EGFR-mutation-positive NSCLC. Also, there is uncertainty about the optimum treatment duration and the long-term benefit of pembrolizumab. As these factors apply to the PD-1 inhibitor class as a whole it is recommended that the decision to review TA428 is deferred until after the CDF reconsideration of the other PD-1 inhibitor, nivolumab (recommended for use in the Cancer Drugs Fund in TA483 and TA484).

NICE’s Guidance Executive decided to proceed with this proposal without consultation.

Consequently TA347, TA374, TA395, TA403 and TA422 will move to the ‘static list’ of technology appraisals and the decision to review TA428 will be deferred until after the CDF reconsideration of TA483 and TA484.

Review proposal paper

Stakeholder list

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