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Nivolumab with ipilimumab for untreated unresectable malignant pleural mesothelioma

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1 Recommendations

1.1 Nivolumab plus ipilimumab is not recommended, within its marketing authorisation, for untreated unresectable malignant pleural mesothelioma in adults.

1.2 This recommendation is not intended to affect treatment with nivolumab plus ipilimumab that was started in the NHS before this guidance was published. People having treatment outside this recommendation may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS clinician consider it appropriate to stop.

Why the committee made these recommendations

Standard care for untreated unresectable malignant pleural mesothelioma is chemotherapy.

Clinical trial evidence suggests that nivolumab plus ipilimumab may extend how long people live compared with chemotherapy, but for how long is uncertain.

Whether nivolumab plus ipilimumab is cost effective is currently unknown because of uncertainties in the clinical evidence and the economic model. It likely meets NICE's criteria for being a life-extending treatment at the end of life. However, because its cost effectiveness is uncertain, it is not recommended for routine use in the NHS. Nivolumab plus ipilimumab does not meet the criteria to be considered for the Cancer Drugs Fund because it currently does not have the potential to be cost effective. Therefore, it is not recommended for use in the Cancer Drugs Fund.