This guidance has been partially updated by NICE technology appraisal guidance 242.

Bevacizumab in combination with 5-fluorouracil plus folinic acid, with or without irinotecan, is not recommended for people with metastatic colorectal cancer who have not been treated before.

Cetuximab in combination with irinotecan is not recommended for people with metastatic colorectal cancer who have had previous treatment for the cancer that also included irinotecan.

Consultants should not stop prescribing bevacizumab or cetuximab for people who were already taking it when the guidance was issued. These patients should be able to carry on taking bevacizumab or cetuximab until they and their consultants decide that it is the right time to stop treatment.

Your responsibility

The recommendations in this guidance represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, health professionals are expected to take this guidance fully into account, alongside the individual needs, preferences and values of their patients. The application of the recommendations in this guidance is at the discretion of health professionals and their individual patients and do not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.

Commissioners and/or providers have a responsibility to provide the funding required to enable the guidance to be applied when individual health professionals and their patients wish to use it, in accordance with the NHS Constitution. They should do so in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities.

Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.