1.1 Nivolumab plus ipilimumab is recommended, within its marketing authorisation, as an option for treating metastatic colorectal cancer with high microsatellite instability (MSI) or mismatch repair (MMR) deficiency after fluoropyrimidine-based combination chemotherapy. It is recommended only if the company provides nivolumab and ipilimumab according to the commercial arrangement.
Why the committee made these recommendations
People with previously treated metastatic colorectal cancer that has high MSI or MMR deficiency are usually offered combination chemotherapy including FOLFOX, FOLFIRI or trifluridine–tipiracil, and best supportive care. This is the same as what is offered for most other types of metastatic colorectal cancer.
Clinical trial evidence suggests that nivolumab plus ipilimumab may extend how long people live. The most relevant trial did not directly compare nivolumab plus ipilimumab with usual treatments, but indirect comparisons suggest that it substantially increases how long it takes for the cancer to get worse and how long people live.
The cost-effectiveness estimates are within what NICE normally considers an acceptable use of NHS resources. So, nivolumab plus ipilimumab is recommended.