NICE have published their draft guidance today for the routine commissioning of a potentially life-extending treatment, for untreated metastatic colorectal cancer. The draft guidance recommends pembrolizumab (also called Keytruda) for untreated metastatic colorectal cancer with high microsatellite instability (MSI) or mismatch repair (MMR) deficiency.
Around 4% of metastatic colorectal cancer patients experience high MSI or MMR deficiencies. Colorectal cancer with high MSI or MMR deficiency is associated with a poorer prognosis, and a greater risk of death than colorectal cancer that is microsatellite stable. There are currently no specific treatments for this type of colorectal cancer.
Evidence in the clinical trial has shown that pembrolizumab may be more effective at extending life, because it increases the time left before the cancer worsens, compared with current treatments such as chemotherapy. However, the independent appraisal committee found the long-term evidence is limited so it is uncertain how much overall survival benefit it offers.
The clinical trial stopped the pembrolizumab treatment after two years, because there was no evidence that there would be any additional benefits from treatment beyond two years. The draft guidance therefore recommends that treatment is stopped at 2 years if there is no evidence that a person’s disease has got worse.
Meindert Boysen, Deputy Chief Executive and Director of the Centre for Health Technology Evaluation at NICE, said: “Pembrolizumab has shown the potential to extend the lives of hundreds of people with this form of colorectal cancer. It also works in a different way to current standard care with chemotherapy.
“The committee heard that people appreciated its faster and less frequent administration, and preferable adverse effects compared with chemotherapy. We are pleased, therefore, to be able to recommend pembrolizumab for routine use in the NHS.”
Pembrolizumab is given intravenously every 3 weeks, and around 450 people will be eligible for the treatment in England. The average cost of a single administration is £5,260 at its list price, but it will be available to the NHS at a discounted price through a confidential arrangement.
NICE are expected to publish the final guidance on pembrolizumab in June 2021.