The National Institute for Health and Care Excellence (NICE) has issued a preliminary rejection of NHS funds for use of Merck Serono's Bavencio (avelumab) as maintenance treatment of locally advanced or metastatic urothelial cancer.

Currently, there are no maintenance treatments routinely available for locally advanced or metastatic urothelial cancer that has responded to platinum-based chemotherapy.

However, in an appraisal consultation document, NICE said while clinical trial evidence shows that Bavencio can delay disease progression and extend survival versus best supportive care, it is uncertain how long people in the NHS who would be eligible for avelumab actually live for.

The most likely cost-effectiveness estimates, it says, “are much higher than what NICE normally considers an acceptable use of NHS resources”.

As such, it was not able to recommend the drug for the traditional funding pathway nor for the Cancer Drugs Fund, as the drug is “unlikely to be cost effective and further data collection is not an option” in this setting.

Bavencio was approved for the maintenance treatment of locally advanced or metastatic urothelial carcinoma – the most common type of bladder cancer – back in January, on the back of the JAVELIN Bladder 100 trial.

Bavencio plus best standard care treated patients demonstrated median overall survival of 21.4 months compared to 14.3 months in the co-primary population of all randomised patients.