We present a letter written from Professor Benger (Chief Medical Officer, Deputy CEO and Interim Director of the Centre of Guidelines, and NICE National Institute for Health and Care Excellence) with regards to the recent discussion on Tumour Treating Fields (TTFs).
Dear Professor Davis,
Thank you for your letter of 1st May 2025 regarding guidance on Tumour Treating Fields (TTF). This has been the subject of extensive correspondence and a meeting between myself and Novocure during the past 18 months.
In 2024 we formally reviewed and updated our guidance review and prioritisation process. Topics for new or updated guidance are now considered through an integrated, cross-organisational prioritisation board (the NICE Prioritisation Board), which makes decisions as to whether NICE should create new, or update existing, guidance.
The topic of TTF was discussed at the Prioritisation Board meeting on 24 July 2024, and it was decided not to prioritise the topic at that time. The Prioritisation Board reviewed this topic directly at stage 2 of its prioritisation process, which included assessments of: budget impact; system impact; population impact; evidence availability and quality; health inequalities; environmental sustainability. Careful consideration was given to the clear need for new treatment options for glioblastoma, the current availability of evidence on which to base recommendations for Optune® (Novocure), and the resource implications of deploying this technology as an adjunct to current therapy.
The Board noted that the technology has a limited evidence base and significant cost, concluding that it would not be a responsible use of NICE resources to proceed with a further evaluation of clinical and cost-effectiveness at this time since the likelihood of making a significant change to our current recommendations was very low. In view of the multiple studies that are planned or underway, it was agreed that this topic should be reconsidered in the future once the results of this additional research are available. In the meantime, we will actively monitor these trials, and any other relevant information that may become available, to identify the optimal point at which this technology should be reconsidered by the NICE Prioritisation Board.
The Prioritisation Board noted that Optune® has been assessed by other health technology assessment agencies within their respective jurisdictions, with recommendations being made over a range of cost-effectiveness thresholds. While NICE does take a broad view of such information, each agency makes their own decisions using their own methods and processes. The systems in place to manage the funding and delivery of healthcare in other countries are different, so direct comparisons cannot be made and NICE’s decisions must be reached independently in the context of the NHS and care system.
NICE provides rigorous, independent assessment of the evidence in making its decisions, and this was the basis of our recommendations in the guideline on brain tumours (primary) and brain metastases in over 16s [NG99] published in 2018 and updated in 2021. This technology was also presented to the former Topic Selection Oversight Panel in December 2022 and shadow Prioritisation Board in March 2024, as well as to the Prioritisation Board in July 2024, in line with our published processes. In all cases, limitations in the evidence demonstrating clinical effectiveness and improvements to quality of life outcomes were noted as being unfavourable for a potentially positive cost-effectiveness analysis.
The urgent need for effective treatments in glioblastoma is recognised by NICE, which also acknowledges the importance of supporting innovation in the life sciences sector. NICE is a founding member of initiatives such as the Innovative Devices Access Pathway, which are designed to serve this purpose.
Thank you for your kind invitation to the Brain Tumour North West Annual Retreat in December. Unfortunately, I am unable to attend, however I wish you every success with this event.
I appreciate this response will come as a disappointment, and am very conscious of the responsibility that NICE carries when making decisions of this type. However, I want to assure you that NICE will continue to monitor the evidence that is generated over the coming months and stands ready to reconsider this technology in the light of emerging research.
Yours sincerely,
Jonathan.
