Nivolumab with ipilimumab for untreated unresectable malignant pleural mesothelioma

1.1 Nivolumab plus ipilimumab is recommended as an option for untreated unresectable malignant pleural mesothelioma in adults, only if:

1.2 This recommendation is not intended to affect treatment with nivolumab plus ipilimumab 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 clinician consider it appropriate to stop.

Why the committee made these recommendations

Standard care for untreated unresectable malignant pleural mesothelioma is chemotherapy.

The clinical trial evidence was in people with an ECOG performance status of 0 or 1. It suggests that nivolumab plus ipilimumab is likely to extend how long people live compared with chemotherapy.

Nivolumab plus ipilimumab likely meets NICE's criteria for being a life-extending treatment at the end of life. Taking this into account, the cost-effectiveness estimates for nivolumab plus ipilimumab were within the range that NICE normally considers an acceptable use of NHS resources. So, it is recommended.