Nivolumab plus ipilimumab can be used, within its marketing authorisation, as an option for untreated unresectable or metastatic colorectal cancer with high microsatellite instability or mismatch repair deficiency in adults. Nivolumab plus ipilimumab can be used only if the company provides it according to the commercial arrangements.
What this means in practice
Nivolumab plus ipilimumab must be funded in the NHS in England for the condition and population in the recommendation, if it is considered the most suitable treatment option. Nivolumab plus ipilimumab must be funded in England within 90 days of final publication of this guidance.
There is enough evidence to show that nivolumab plus ipilimumab provides clinical benefits and value for money, so it can be used routinely across the NHS in this population.
NICE has produced tools and resources to support the implementation of this guidance.
Usual treatment for untreated unresectable or metastatic colorectal cancer with high microsatellite instability or mismatch repair deficiency in adults is pembrolizumab or chemotherapy.
Clinical trial evidence shows that, compared with chemotherapy, nivolumab plus ipilimumab increases how long people have before their cancer gets worse and how long they live. Indirect comparisons suggest that nivolumab plus ipilimumab also increases how long people have before their cancer gets worse and how long they live compared with pembrolizumab.
The cost-effectiveness estimates are within the range that NICE considers an acceptable use of NHS resources. So, nivolumab plus ipilimumab can be used.