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Enfortumab vedotin with pembrolizumab for untreated unresectable or metastatic urothelial cancer when platinum-based chemotherapy is suitable [ID6332]

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1 Recommendations

1.1

Enfortumab vedotin with pembrolizumab should not be used for untreated unresectable or metastatic urothelial cancer in adults who can have platinum-based chemotherapy.

1.2

This recommendation is not intended to affect treatment with enfortumab vedotin with pembrolizumab 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

Enfortumab vedotin with pembrolizumab is not required to be funded in the NHS in England for untreated unresectable or metastatic urothelial cancer when platinum-based chemotherapy is suitable. So, it should not be used routinely in the NHS in England.

This is because the available evidence does not suggest that enfortumab vedotin with pembrolizumab is value for money.

Why the committee made these recommendations

For unresectable or metastatic urothelial cancer when platinum-based chemotherapy is suitable, usual treatment is first-line carboplatin or cisplatin (both platinum-based chemotherapies) plus gemcitabine, and then maintenance avelumab if the cancer has not got worse.

Clinical trial evidence shows that enfortumab vedotin with pembrolizumab increases how long people have before their cancer gets worse and how long they live compared with usual treatment.

But, there are uncertainties in the economic evidence. This is because people in the clinical trial had subsequent treatments that are not currently recommended in the NHS and this was not adjusted for in the economic model. It is also unclear how best to estimate how long people have avelumab maintenance treatment for in the NHS.

The cost-effectiveness estimates are above the range that NICE considers an acceptable use of NHS resources. So, enfortumab vedotin with pembrolizumab should not be used.