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SMC approves first immunotherapy combination for advanced bowel cancer patients with rare mutation

Nivolumab plus ipilmumab has been accepted as a treatment option for adult patients by NHS Scotland for patients who have previously failed fluoropyrimidine-based chemotherapy.

Bristol Myers Squibb (BMS) announced the Scottish Medicines Consortium (SMC) has accepted nivolumab plus ipilmumab as a treatment option for adults with mismatch repair deficient (dMMR) or microsatellite instability-high (MSIH) advanced colorectal (bowel) cancer. The therapy is for use by NHS Scotland after patients have previously failed fluoropyrimidine-based chemotherapy. The decision marks the first immunotherapy combination approved in Scotland for this patient group, which have a form of advanced bowel cancer.

“Until now, clinicians had very limited treatment options to offer patients with this rare form of advanced bowel cancer, when chemotherapy fails,” shared Dr Janet Graham, consultant oncologist at the Beatson West of Scotland. “The acceptance of this combination of nivolumab and ipilimumab is an advance for these patients with this rare form of advanced bowel cancer and will allow us to offer our patients a new treatment option to potentially combat this devastating disease.”

Patients in this group are characterised by rare gene mutations known as MSI-H or dMMR, which affect how cancer grows. Bowel cancer is a significant public health issue in Scotland, which has a higher rate of cancer than most other countries in the Western world. It is the third most commonly diagnosed cancer in both men and women in Scotland, with around 3,700 new cases diagnosed in 2017. The SMC recommendation is based on data from an ongoing CheckMate-142 study, showing an objective response rate (ORR) of 65% after a follow up of 51 months.

“This decision by the SMC may bring new optimism for this small group of advanced bowel cancer patients in Scotland who, until now, have faced very limited treatment options,” said Dr Lisa Wilde, director of research and external affairs at Bowel Cancer UK. “We submitted evidence to SMC to highlight the impact of living with stage 4 bowel cancer and the potential benefits of immunotherapy, and we’re really pleased that this was considered in the decision-making.”