NICE has recommended oxaliplatin (trade name Eloxatin) as a first line combination treatment with 5-fluorouracil and folinic acid (5FU/FA) for patients where the cancer has only spread to the liver and may be operable after treatment.
Evidence, that was considered by NICE, indicated that treating patients in these specific circumstances with oxaliplatin and 5FU/FA could shrink liver tumours sufficiently to permit surgery.
It could also increase 5-year survival rates from approximately 3% to between 28 to 34%.
Routine first-line treatment using oxaliplatin and 5FU/FA combination treatments are not recommended on the basis of the balance of their clinical and cost-effectiveness. This was because NICE found no statistically significant evidence that this treatment increases survival rates.
Irinotecan (trade name Campto) is recommended as a second line monotherapy, for patients where 5FU-containing treatment has failed or where 5FU is inappropriate.
Irinotecan combination treatments with 5FU/FA are not recommended as routine first-line treatment, on the basis of insufficiently robust evidence of their clinical and cost-effectiveness.
On the basis of the evidence viewed by NICE, raltitrexed (Tomudex) is not recommended for use outside appropriately designed clinical studies.
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NICE recommends that patients who are currently receiving irinotecan or oxaliplatin, in combination with 5FU/FA or raltitrexed, may wish to continue this therapy until they and their consultant consider it is appropriate to stop.
This is because they could suffer loss of well-being if their treatment is discontinued at a time they did not anticipate.
The Institute's Clinical Director, Professor Peter Littlejohns, said, "This guidance means patients should now have equal access to these treatments wherever they live.
"The Institute's guidance is underpinned by a careful analysis of the evidence, balancing clinical and cost effectiveness. We will not recommend a treatment where these criteria have not been satisfied."
"We have recommended use of both irinotecan and oxaliplatin in specific circumstances where cancer patients will benefit.
"However, the available data does not support widespread use of these drugs, and they should only be considered in the circumstances specified in the guidance," he concluded.