In its latest draft guidance NICE has not recommended imatinib (Glivec) at doses of 600 or 800 mg/day for people with unresectable and/or metastatic gastrointestinal stromal tumours (GIST) whose disease has progressed after treatment with 400 mg/day imatinib.
Draft guidance is now with consultees, who have the opportunity to appeal against the proposed guidance. Until NICE issues final guidance, NHS bodies should make decisions locally on the funding of specific treatments.
Andrew Dillon, Chief Executive of NICE said: “NICE has previously recommended imatinib at a dose of 400 mg/day to treat GISTs that cannot be removed by surgery[1] and also recommends sunitinib (Sutent) for patients for whom treatment with 400 mg/day of imatinib has not worked or is not suitable[2]. This review looks specifically at increased doses of imatinib after treatment with 400 mg/day imatinib has stopped working. The higher doses of imatinib being considered are 600 mg/day and 800 mg/day.
“The independent Appraisal Committee found that since the original guidance was published in October 2004, there have been no new good quality clinical and cost effectiveness data produced on doses of 600 or 800 mg/day imatinib given after disease progression on a dose of 400 mg/day*. On this basis, we cannot recommend these higher doses of imatinib for use on the NHS.”
GISTs are rare tumours which occur predominantly in the stomach or bowel. Many of these tumours can be removed by surgery but some cannot (unresectable tumours). Without treatment unresectable GISTs progress and will eventually metastasise.
Source: NICE