This guidance updates and replaces NICE technology appraisal 150 (published in June 2008).
This guidance partially updates and replaces NICE technology appraisal 118 (published in January 2007)
NICE does not recommend cetuximab (on its own or in combination with chemotherapy) for people with metastatic colorectal cancer that has progressed (worsened) after first-line (first course) chemotherapy.
NICE does not recommend bevacizumab in combination with a fluoropyrimidine-based chemotherapy regimen for people with metastatic colorectal cancer that has progressed after first-line chemotherapy.
NICE does not recommend panitumumab on its own for people with metastatic colorectal cancer that has progressed after first-line chemotherapy.
Why has NICE said this?
NICE looks at how well treatments work, and also at how well they work in relation to how much they cost the NHS. NICE applies special considerations to treatments that can extend the lives of people who are nearing the end of their life.
Cetuximab does not provide enough benefit to patients to justify its high cost and did not qualify for special consideration.
There was no evidence available to assess whether bevacizumab in combination with a fluoropyrimidine-based chemotherapy regimen works for people with metastatic colorectal cancer that has worsened after first-line chemotherapy, so NICE could not recommend it.
Panitumumab does not provide enough benefit to patients to justify its high cost even when the special considerations were applied.
Since the publication of TA242 the populations covered by the marketing authorisation have changed:
Panitumumab: from ‘patients with wild-type KRAS metastatic colorectal cancer’ to ‘patients with wild-type RAS metastatic colorectal cancer’.
Cetuximab: from ‘patients with EGFR-expressing metastatic colorectal cancer with non-mutated (wild-type) KRAS’ to ‘patients with epidermal growth factor receptor (EGFR)-expressing, RAS wild-type metastatic colorectal cancer’.
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.