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Fruquintinib for previously treated metastatic colorectal cancer

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1 Recommendations

1.1

Fruquintinib is not recommended, within its marketing authorisation, for treating metastatic colorectal cancer in adults who have had previous treatment, including:

  • fluoropyrimidine-, oxaliplatin-, and irinotecan-based chemotherapy, with or without an anti-vascular endothelial growth factor [VEGF] treatment, and

  • if the cancer is RAS wildtype, an anti-epidermal growth factor receptor [EGFR] treatment if that is appropriate.

1.2

This recommendation is not intended to affect treatment with fruquintinib 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 treatment with chemotherapy (with or without anti-VEGF treatment) and anti-EGFR treatment includes regorafenib and trifluridine–tipiracil.

Clinical trial evidence shows that fruquintinib increases how long people have before their cancer gets worse and how long they live, compared with placebo. Fruquintinib has not been directly compared in a clinical trial with standard treatment, but an indirect comparison suggests that there is no difference in how long people live with any of these treatments.

There are uncertainties in the economic model. This is because of the method used to estimate how long people live. The cost-effectiveness estimates are unlikely to be within the range NICE normally considers a cost-effective use of NHS resources, and further analysis is needed to resolve the uncertainties. So, fruquintinib is not recommended.