NICE confirms ‘no’ for Zaltrap

Sanofi’s colorectal cancer treatment Zaltrap has been given a final ‘no’ from NICE, despite the firm offering a price cut.

The cost effectiveness watchdog issued final guidance not to recommend Zaltrap (aflibercept) for patients with metastatic colorectal cancer that is resistant to or has progressed after an oxaliplatin containing regimen.

NICE’s independent committee considered Zaltrap to be a clinically effective treatment, but said it could not be considered a cost-effective use of NHS resources even when the patient access scheme submitted by the firm was taken into account.

Sanofi’s drug is one of the weaker players in the colorectal cancer market in terms of evidence – trial data shows it extended overall survival by a median of just 1.44 months when compared to placebo. This, combined with its high price, meant that NICE was always likely to reject the drug.

The drug joins a number of other targeted but high cost treatments for colorectal cancer that NICE has rejected, such as Roche’s Avastin and Amgen’s Vectibix.

NICE points out that it has approved six treatments for colorectal cancer – but it is almost five years since its most recent approval in the field, for Merck Serono’s Erbitux (cetuximab), for patients with a particular sub-type of the disease.

The Institute received an appeal on its final draft Zaltrap guidance for this appraisal from Sanofi, which was heard on 23 January 2014 but dismissed on all points.

Commenting on the final guidance, Sir Andrew Dillon, Chief Executive of NICE, said: “We have already recommended six treatments for various stages of colorectal cancer and are disappointed not to be able to add aflibercept as another treatment option for this stage of the disease. However, we have to be confident that the benefits that drugs offer patients really do justify what the NHS will have to pay for them. Although the independent committee considered aflibercept to be a clinically effective treatment, it could not be considered a cost-effective use of NHS funds.”


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