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Durvalumab with tremelimumab for untreated advanced or unresectable hepatocellular carcinoma

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1 Recommendations

1.1

Durvalumab plus tremelimumab should not be used for untreated advanced or unresectable hepatocellular carcinoma (HCC) in adults.

1.2

This recommendation is not intended to affect treatment with durvalumab plus tremelimumab 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 healthcare professional consider it appropriate to stop.

What this means in practice

There is no requirement to fund durvalumab plus tremelimumab in the NHS in England for untreated advanced or unresectable HCC in adults.

The available evidence does not suggest that durvalumab plus tremelimumab offers value for money, so it should not be used routinely in the NHS in England.

Why the committee made these recommendations

Usual treatment for untreated advanced or unresectable HCC includes atezolizumab plus bevacizumab, lenvatinib or sorafenib. Most people have atezolizumab plus bevacizumab.

Evidence from a clinical trial suggests that durvalumab plus tremelimumab increases how long people live compared with sorafenib. But indirect comparisons of durvalumab plus tremelimumab with atezolizumab plus bevacizumab, lenvatinib and sorafenib are uncertain.

The most likely cost-effectiveness estimate is uncertain and likely to be above what NICE normally considers an acceptable use of NHS resources. So, durvalumab with tremelimumab should not be used.