Selpercatinib for treating advanced thyroid cancer with RET alterations

1.1 Selpercatinib is recommended for use within the Cancer Drugs Fund, as an option for treating:

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. For young people, this decision should be made jointly by the clinician and the young person and the young person's parents or carers.

Why the committee made these recommendations

People with advanced RET fusion-positive thyroid cancer are usually first offered a partial or full thyroidectomy. This is followed by radioactive iodine and then lenvatinib or sorafenib. People with advanced RET-mutant medullary thyroid cancer are usually offered a partial or full thyroidectomy, followed by cabozantinib.

Clinical trial evidence for selpercatinib is highly uncertain because it is based on an ongoing single-arm trial and not all subpopulations represent NHS practice. The results comparing selpercatinib indirectly with best supportive care are also highly uncertain.

Selpercatinib could be cost effective if more data becomes available from the ongoing trial that shows people live longer with treatment. Data from the trial and NHS practice would also help address the uncertainty about its clinical effectiveness. Selpercatinib is therefore recommended for use in the Cancer Drugs Fund so that more data can be collected.