1.1 Nivolumab is recommended, within its marketing authorisation, for treating unresectable advanced, recurrent or metastatic oesophageal squamous cell carcinoma in adults after fluoropyrimidine and platinum-based therapy. It is recommended only if the company provides nivolumab according to the commercial arrangement.
Why the committee made these recommendations
Unresectable advanced, recurrent or metastatic oesophageal squamous cell carcinoma is usually first treated with fluoropyrimidine and platinum-based therapy. Then if the cancer progresses, it is treated with a taxane (docetaxel or paclitaxel).
Clinical trial evidence suggests nivolumab does not increase how long people live without their cancer getting worse compared with taxanes. The trial shows that people are more likely to die in the first 3 months of treatment with nivolumab, even though people with a life expectancy of less than 3 months were not included in the trial. After that, evidence suggests people live for at least 3 months longer if they have nivolumab compared with taxane treatment.
Nivolumab meets NICE's criteria to be considered a life-extending treatment at the end of life. The cost‑effectiveness estimates are uncertain, but are likely to be within what NICE normally considers an acceptable use of NHS resources. So, nivolumab is recommended.