NICE: no evidence to approve Merck Serono's Erbitux, Roche's Avastin and Amgen's Vectibix for second-line mCRC
This article was originally published in Scrip
Merck Serono's Erbitux (cetuximab), Roche's Avastin (bevacizumab) and Amgen's Vectibix (panitumumab) have failed to win recommendations from NICE, the health technology appraisal institute for England and Wales, for the treatment of metastatic colorectal cancer that has progressed after first-line chemotherapy.
The institute has issued final and binding recommendations rejecting the drugs, largely because of a lack of evidence. The appraisal committee had doubts about the overall survival gain of Avastin plus non-oxaliplatin chemotherapy when used as second-line treatment. Meanwhile, the magnitude of the benefit offered by Vectibix compared with best supportive care was uncertain. And finally, the institute was unsure about the overall survival estimates for Erbitux plus irinotecan based on a mixed treatment comparison. Nevertheless, the institute acknowledged the latter extended life in the third-line or later setting compared to best supportive care alone.
NICE was unable to produce a cost-effectiveness evaluation on Avastin because of a lack of evidence on clinical effectiveness. It said the most plausible ICERs for Erbitux plus best supportive care were £90,000 per QALY when compared with best supportive care, and £88,000 per QALY for Erbitux plus irinotecan plus best supportive care, again when compared with best supportive care. The committee could not give a precise ICER for Vectibix compared with best supportive care, but said it would probably be between £110,000 and £150,000 per QALY gained.
NICE issued negative final draft guidance in November (scripintelligence.com, 25 November 2011).