Colorectal cancer patients with rare mutations to benefit from life-extending treatment
NICE recommends pembrolizumab for colorectal cancer patients with rare mutations.
A potentially life-extending treatment for some people with untreated metastatic colorectal cancer, who have specific mutations in their cancer cells, has been approved for routine commissioning by NICE in draft guidance published today (14 May 2021)
The draft guidance recommends pembrolizumab (also called Keytruda and made by Merck Sharp & Dohme) for untreated metastatic colorectal cancer with high microsatellite instability (MSI) or mismatch repair (MMR) deficiency.
High MSI or MMR deficiency occurs in around 4 per cent of metastatic colorectal cancer patients. Around 450 people will be eligible for this treatment in England according to the guidance. Colorectal cancer with high MSI or MMR deficiency is associated with a poorer outlook and a greater risk of death.
There are currently no specific treatments for untreated metastatic colorectal cancer with high microsatellite instability or mismatch repair deficiency.
Pembrolizumab has shown the potential to extend the lives of hundreds of people with this form of colorectal cancer. It also works in a different way to current standard care with chemotherapy and the committee heard that people appreciated its faster and less frequent administration, and preferable adverse effects compared with chemotherapy. We are pleased, therefore, to be able to recommend pembrolizumab for routine use in the NHS.
Clinical trial evidence shows that pembrolizumab increases the time before the cancer gets worse and may also be more effective at extending life. However, the long-term evidence is limited so it is uncertain how much overall survival benefit it offers.
NICE expects to publish final guidance on pembrolizumab in June 2021.