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1 Recommendations

1.1

Serplulimab with carboplatin and etoposide should not be used for untreated extensive-stage small-cell lung cancer in adults.

1.2

This recommendation is not intended to affect treatment with serplulimab with carboplatin and etoposide 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

Serplulimab with carboplatin and etoposide is not required to be funded in the NHS in England for untreated extensive-stage small-cell lung cancer in adults. It should not be used routinely in the NHS in England.

This is because there is not enough evidence to determine whether serplulimab with carboplatin and etoposide offers benefit and is value for money in this population.

Why the committee made these recommendations

Usual treatment for untreated extensive-stage small-cell lung cancer is one of the following:

  • platinum-based chemotherapy alone, such as carboplatin with etoposide

  • atezolizumab with carboplatin and etoposide

  • durvalumab with etoposide and either carboplatin or cisplatin.

Clinical trial evidence shows that serplulimab with carboplatin and etoposide increases how long people have before their condition gets worse and how long people live compared with placebo plus carboplatin and etoposide.

Serplulimab with carboplatin and etoposide has not been directly compared in a clinical trial with either of the other 2 usual treatment options (the atezolizumab or durvalumab combinations). The results of indirect comparisons with these treatment combinations are uncertain because of the methods used.

There are also uncertainties in the economic model, including:

  • whether the model reflects what would happen in the NHS

  • the differences in how long people are expected to stay on the different treatments

  • the effects of treatment on quality of life, which are higher than would be expected for people with extensive-stage small-cell lung cancer.

Because of the uncertainties in the clinical evidence and the economic model, it is not possible to determine the most likely cost-effectiveness estimates for serplulimab with carboplatin and etoposide. So, it should not be used.