The National Institute of Health and Clinical Excellence (NICE) has recently published guidelines regarding the use of three new medications cetuximab, bevacizumab, and panitumumab in the treatment of late-stage colorectal cancer that has progressed despite first-line chemotherapy. It has rejected the use of all these three drugs in metastatic colorectal cancer.
Colorectal cancer affects the lower digestive tract comprising of the colon and rectum. It lists among the most common cancers in the developed countries. It can spread to neighboring organs or distant sites; spread to distant sites is referred to as metastasis. Depending on the stage of the cancer, it is treated with surgery, chemotherapy, radiation or biological therapy with monoclonal antibodies.
AdvertisementNICE is the UK authority that authorizes treatments for use in the National Health Service. Currently, it recommends two treatments for metastatic cancer that has progressed after first-line treatment with chemotherapy: irinotecan for people who previously received FOLFIRI (irinotecan in combination with 5-fluorouracil plus folinic acid), and FOLFOX (oxaliplatin in combination with 5-fluorouracil plus folinic acid) for people who previously received FOLFIRI.
The three medications, cetuximab, bevacizumab, and panitumumab belong to a group called monoclonal antibodies. These were suggested by their manufacturers to be useful in the treatment of metastatic colorectal cancer that has progressed despite the use of preferred chemotherapy. The evidence regarding the usefulness of these medications was provided based on clinical trials.
The Committee evaluating these agents did agree that cetuximab plus best supportive care improved survival in colorectal cancer patients with metastasis compared to best supportive care alone. However, there was some degree of uncertainty in the claims that cetuximab plus irinotecan could improve overall survival.
Treatment with panitumumab as a third-line or later agent improved progression-free survival of roughly 5 weeks compared with best supportive care, but the committee felt that the true magnitude of the survival benefit was uncertain.
Among the three medications under evaluation, the committee felt that evidence failed to establish that bevacizumab when administered with non-oxaliplatin chemotherapy improved overall survival.
Treatment with cetuximab and panitumumab were not found to be cost-effective.
1. NICE guidance on cetuximab, bevacizumab, and panitumumab for treatment of metastatic colorectal cancer after first-line chemotherapy; Fiona Rinaldi et al; The Lancet Oncology.