1 Recommendations

1.1

Bevacizumab (originator and biosimilars) with fluoropyrimidine-based chemotherapy can be used as an option to treat metastatic colorectal carcinoma in adults:

as first- and second-line treatment only, when
targeted treatments or immunotherapy are unsuitable, and
chemotherapy would otherwise be offered.

Bevacizumab with fluoropyrimidine-based chemotherapy can only be used if the companies have an agreed price within the Medicines Procurement and Supply Chain.

1.2

This recommendation is not intended to affect treatment with bevacizumab with fluoropyrimidine-based chemotherapy 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 healthcare professional consider it appropriate to stop.

What this means in practice

Bevacizumab (originator and biosimilars) with fluoropyrimidine-based chemotherapy must be funded in the NHS in England for the condition and population in the recommendations, if it is considered the most suitable treatment option. Bevacizumab with fluoropyrimidine-based chemotherapy must be funded in England within 90 days of final publication of this guidance.

There is enough evidence to show that bevacizumab with fluoropyrimidine-based chemotherapy provides benefits and value for money, so it can be used routinely across the NHS in this population.

NICE has produced tools and resources to support the implementation of this guidance.

Why the committee made these recommendations

For this evaluation, bevacizumab (originator and biosimilars) plus fluoropyrimidine-based chemotherapy was considered only for the first- and second-line treatment of metastatic colorectal carcinoma when targeted treatments or immunotherapy are not suitable, and chemotherapy alone would otherwise be offered. This does not include the whole population it is licensed for.

Usual first- and second-line treatment for metastatic colorectal cancer when targeted treatments or immunotherapy are not suitable is fluoropyrimidine-based chemotherapy alone. Bevacizumab would be used as well as chemotherapy.

Clinical trial evidence shows that bevacizumab plus chemotherapy increases how long people have before their cancer gets worse and how long they live compared with placebo plus chemotherapy.

The economic model has uncertainties because of the assumptions used. But when considering the condition's severity, and its effect on quality and length of life, the cost-effectiveness estimates are within the range NICE considers an acceptable use of NHS resources. So, bevacizumab (originator or biosimilars) with fluoropyrimidine-based chemotherapy can be used.