Pembrolizumab plus chemotherapy with or without bevacizumab is recommended as an option for treating persistent, recurrent or metastatic cervical cancer in adults whose tumours express PD‑L1 with a combined positive score of at least 1. It is recommended only if:
pembrolizumab is stopped at 2 years of uninterrupted treatment, or earlier if the cancer progresses, and
the company provides it according to the commercial arrangements.
This recommendation is not intended to affect treatment with pembrolizumab plus chemotherapy with or without 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 clinician consider it appropriate to stop.
Why the committee made these recommendations
This rapid review considers new evidence that has become available on pembrolizumab plus chemotherapy with or without bevacizumab for persistent, recurrent or metastatic cervical cancer since the publication of NICE's technology appraisal guidance TA885.
Standard care for persistent, recurrent or metastatic cervical cancer includes chemotherapy with or without bevacizumab. Evidence from a clinical trial shows that, compared with standard care, pembrolizumab plus chemotherapy with or without bevacizumab increases the time it takes for the cancer to get worse. It also suggests that it increases how long people live. In this trial, people had pembrolizumab for up to 2 years.
Pembrolizumab plus chemotherapy with or without bevacizumab meets NICE's criteria to be considered a life-extending treatment at the end of life. When taking this into account, the cost-effectiveness estimates are within the range that NICE considers an acceptable use of NHS resources. So, pembrolizumab plus chemotherapy with or without bevacizumab is recommended.