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  • Question on Document

    Has all of the relevant evidence been taken into account?

  • Question on Document

    Are the summaries of clinical and cost effectiveness reasonable interpretations of the evidence?

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    Are the recommendations sound and a suitable basis for guidance to the NHS?

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1 Recommendations

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1 Recommendations

1.1

Trifluridine–tipiracil with bevacizumab is not recommended, within its marketing authorisation, for treating metastatic colorectal cancer in adults who have had 2 lines of treatment (including fluoropyrimidine-, oxaliplatin- and irinotecan-based chemotherapies, anti-vascular endothelial growth factor or anti-epidermal growth factor receptor treatments).

1.2

This recommendation is not intended to affect treatment with trifluridine–tipiracil plus bevacizumab that was started in the NHS before this guidance was published. People having treatment outside this recommendation may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS healthcare professional consider it appropriate to stop.

Why the committee made these recommendations

Standard treatment for metastatic colorectal cancer after 2 lines of treatment includes trifluridine–tipiracil alone or regorafenib.

The results of a clinical trial show that, compared with trifluridine–tipiracil alone, trifluridine–tipiracil plus bevacizumab increases how long people have before their cancer gets worse and how long they live. The results of an indirect comparison also suggest similar benefits for trifluridine–tipiracil plus bevacizumab compared with regorafenib.

The cost-effectiveness estimates are uncertain because of assumptions used in the economic model about how long people live on trifluridine–tipiracil plus bevacizumab and trifluridine–tipiracil alone. So, further analysis is needed, and trifluridine–tipiracil plus bevacizumab is not recommended.