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 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.
NICE 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
medications, cetuximab, bevacizumab, and panitumumab belong to a group called
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