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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?

  • Question on Document

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

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    Are there any aspects of the recommendations that need particular consideration to ensure we avoid unlawful discrimination against any group of people on the grounds of age, disability, gender reassignment, pregnancy and maternity, race, religion or belief, sex or sexual orientation?
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1 Recommendations

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2 Information about trifluridine–tipiracil plus bevacizumab

Marketing authorisation indication

2.1

Trifluridine–tipiracil (Lonsurf, Servier Laboratories) plus bevacizumab is indicated for 'the treatment of adult patients with metastatic colorectal cancer (CRC) who have received two prior anticancer treatment regimens including fluoropyrimidine-, oxaliplatin- and irinotecan-based chemotherapies, anti-VEGF agents, and/or anti-EGFR agents'.

Price

2.3

The list price of trifluridine–tipiracil (15 mg/6.14 mg) is £500 per 20‑tablet pack and £1,500 per 60‑tablet pack (excluding VAT; BNF accessed May 2024). The list price of trifluridine–tipiracil (20 mg/8.19 mg) is £666.67 per 20‑tablet pack and £2,000 per 60‑tablet pack. (excluding VAT; BNF accessed May 2024).

2.4

The list price of bevacizumab (25 mg/ml) varies between £205.00 and £242.66 per 4‑ml vial, and between £810.00 and £924.40 per 16‑ml vial (excluding VAT; BNF accessed May 2024).

2.5

The company has a commercial arrangement. This makes trifluridine–tipiracil available to the NHS with a discount, and it would have also applied to this indication if the technology had been recommended. The size of the discount is commercial in confidence.

2.6

There is a discount for bevacizumab agreed with the Commercial Medicines Unit. The prices agreed through the framework are commercial in confidence.