1 Recommendations

1.1 Nivolumab with ipilimumab is recommended, within its marketing authorisation, as an option for untreated advanced renal cell carcinoma in adults:

  • whose disease is intermediate or poor risk as defined in the International Metastatic Renal Cell Carcinoma Database Consortium criteria and

  • only if the company provides nivolumab with ipilimumab according to the commercial arrangement.

Why the committee made these recommendations

This appraisal reviews the additional evidence collected as part of the Cancer Drugs Fund managed access agreement for nivolumab with ipilimumab for untreated advanced renal cell carcinoma.

Current NHS treatment for untreated advanced renal cell carcinoma with intermediate to poor risk is usually sunitinib, pazopanib, cabozantinib or tivozanib. Because cabozantinib and tivozanib were not established clinical practice in the NHS at the time of the original appraisal of nivolumab with ipilimumab, they were not included in the scope for this review.

The new clinical trial evidence shows that nivolumab with ipilimumab improves how long people live compared with sunitinib. Sunitinib and pazopanib are considered to be similarly effective.

The most likely cost-effectiveness estimates for nivolumab with ipilimumab are within the range that NICE usually considers an acceptable use of NHS resources. Therefore, it is recommended for routine use in the NHS.

  • National Institute for Health and Care Excellence (NICE)