The National Institute for Health and Care Excellence has again rejected Sanofi's metastatic colorectal cancer drug Zaltrap, saying it is too expensive.

The cost watchdog has issued final guidance that does not recommend Zaltrap (aflibercept) for treating metastatic colorectal cancer that is resistant to or has progressed after an oxaliplatin-containing regimen. NICE had originally turned down the drug and heard Sanofi's appeal in January and the latter "was dismissed on all points".

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

NICE chief executive Sir Andrew Dillon said: “we have already recommended sixtreatments 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".