1.1
Tarlatamab should not be used to treat extensive-stage small-cell lung cancer in adults whose cancer has progressed after 2 or more lines of treatment, including platinum-based chemotherapy.
1 Recommendation
1.2
This recommendation is not intended to affect treatment with tarlatamab 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
Tarlatamab is not required to be funded and should not be used routinely in the NHS in England for the condition and population in the recommendation.
This is because the available evidence does not suggest that tarlatamab is value for money in this population.
Why the committee made this recommendation
There are no approved treatments for extensive-stage small-cell lung cancer that has progressed after 2 or more lines of treatment that included platinum-based chemotherapy. So, people usually have chemotherapy again or best supportive care.
Clinical trial evidence suggests that tarlatamab increases how long people have before their cancer gets worse and how long they live. But, the extent of this benefit is uncertain because the trial did not compare tarlatamab with chemotherapy. It has been indirectly compared with chemotherapy but the results are uncertain.
Because of the uncertainties in the clinical evidence, the cost-effectiveness estimates are also uncertain. All the cost-effectiveness estimates are above the range that NICE considers an acceptable use of NHS resources. So, tarlatamab should not be used.