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1 Recommendations

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1 Recommendations

1.1

Adagrasib should not be used to treat KRAS G12C mutation-positive advanced non-small-cell lung cancer (NSCLC) in adults whose cancer has progressed after, or who cannot tolerate, platinum-based chemotherapy or anti-PD-1 or anti-PD-L1 immunotherapy.

1.2

This recommendation is not intended to affect treatment with adagrasib 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

Adagrasib is not required to be funded in the NHS in England to treat KRAS G12C mutation-positive advanced NSCLC in adults whose cancer has progressed after, or who cannot tolerate, platinum-based chemotherapy or anti-PD-1 or anti-PD-L1 immunotherapy. It should not be used routinely in the NHS in England.

This is because there is not enough evidence to determine whether adagrasib is value for money.

Why the committee made these recommendations

Usual treatment for previously treated KRAS G12C mutation-positive advanced NSCLC includes docetaxel or docetaxel plus nintedanib, and platinum-based chemotherapy. Adagrasib is a treatment targeted to the KRAS G12C mutation.

Clinical trial evidence shows that adagrasib increases how long people have before their cancer gets worse compared with docetaxel. But it is uncertain whether adagrasib increases how long people live compared with docetaxel. This is because of how the clinical trial was designed and because it is still ongoing.

Adagrasib has not been directly compared in a clinical trial with docetaxel plus nintedanib. Results from an indirect comparison are uncertain.

There are concerns with the economic model. This is because of assumptions made about the effect of adagrasib on quality of life. Because of the uncertainties in the clinical evidence and in the economic model it is not possible to determine the most likely cost-effectiveness estimates for adagrasib.

So, it should not be used.