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NICE decide not to update CUP Guideline for now

April 18, 2023

The NICE Surveillance Team have decided not to update the Guideline at the moment but to keep it under review.  Their reasoning is shown here. They have however agreed one change which reflects the introduction of Whole Genome Sequencing in England in October 2022:

Due to changes in practice, we will replace recommendation that says not to use gene-expression-based profiling for diagnosis, with a cross-reference to the NHS Genomic Medicine Service, which provides information on available options for gene-expression-based profiling. We will also withdraw recommendation, as while insufficient evidence exists for a recommendation on treatment options informed by the results of gene-expression-based profiling, we wish to remove the ‘do not use’ statement as there is ongoing research within this area.

Whilst not explicit, we might deduce from their report that they will review this decision when the findings of the CUPISCO study are published in the Autumn as well as other trials that are also close to reporting such as CUP-COMP. It is encouraging that they seem to have in mind the need for  a full review hinging on clearer evidence of molecular diagnostic testing  providing patient benefit:

……recommendations on organisation of services and support, diagnosis, factors influencing management decisions, managing specific presentations and systemic treatment should be considered for update when the molecular diagnostic test evidence is available.



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