Selpercatinib [SEL1]
For the treatment of adults or adolescents aged 12 years and older with previously treated RET fusion positive non-medullary thyroid cancer where the following criteria have been met:
- This application is being made by and the first cycle of systemic anti-cancer therapy with selpercatinib will be prescribed by a consultant specialist specifically trained and accredited in the use of systemic anti-cancer therapy.
- This patient has a proven histological or cytological diagnosis of non-medullary thyroid cancer (there is a separate form SEL02 for selpercatinib in medullary thyroid cancer). Please enter below as to which type of thyroid cancer this patient has:
- papillary thyroid cancer or
- follicular thyroid cancer or
- Hurtle cell thyroid cancer or
- anaplastic thyroid cancer
- This patient’s thyroid cancer has been documented as having a RET fusion as determined by a validated genomic test. Please enter below as to which is the RET fusion partner in this patient’s thyroid cancer:
- CCDC6 or
- NCOA4 or
- another fusion partner
- The patient is either an adult or an adolescent aged 12 years and older. Please indicate which applies:
- the patient is an adult or
- the patient is an adolescent Note: if the patient is an adolescent, open growth plates should be monitored.
- Either the patient’s disease is refractory to radioactive iodine or that treatment with radioactive iodine is inappropriate.
- Either the patient has differentiated thyroid cancer (papillary/follicular/Hurtle cell) and has therefore been treated with lenvatinib or sorafenib or the patient has anaplastic thyroid cancer in which case no previous TKI treatment requirement is necessary. Please enter below as to the previous TKI therapy that the patient has received:
- lenvatinib for differentiated thyroid cancer or
- sorafenib for differentiated thyroid cancer or
- has anaplastic thyroid cancer and hence no previous TKI therapy
- The patient has an ECOG performance status (PS) of 0 or 1 or 2.
- Selpercatinib is being given as monotherapy.
- The patient has not previously received selpercatinib or any other TKI which targets the RET receptor unless the patient has received selpercatinib via a company early access scheme and the patient meets all the other criteria listed here.
- Selpercatinib is to be continued until disease progression or unacceptable toxicity or patient choice to stop treatment.
- The prescribing clinician is aware of the following issues as regards the administration of selpercatinib as detailed in its Summary of Product Characteristics (SPC):
- the dosage of selpercatinib is according to body weight
- selpercatinib has reduced solubility at a higher pH and hence precautions are necessary with the co-administration of proton pump inhibitors or H2 antagonists
- selpercatinib has clinically important interactions with CYP3A inhibitors or CYP3A inducers
- A formal medical review as to how selpercatinib is being tolerated and whether treatment with selpercatinib should continue or not will be scheduled to occur at least by the start of the third 4-weekly cycle of treatment.
- when a treatment break of more than 6 weeks beyond the expected 4-weekly cycle length is needed, a treatment break approval form will be completed to restart treatment.
- Selpercatinib is to be otherwise used as set out in its Summary of Product Characteristics.
CDF funded From: 01 October 2021
Additional information
Current Form Version
Note
The data on this page was produced using version 1.346 of the CDF list, downloaded from an archive of NHS England’s website on 07 February 2025 at 18:00.
If NHS England has published a new version of the CDF List but this site has not yet accessed that, this form may be out of date. Additionally, if any update has occurred without NHS England noting it as a change, this page will be out of date.