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Colorectal Cancer — SCE Medical Oncology MCQ

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HardGI CancersColorectal CancerSCE Medical Oncology

A patient with dMMR metastatic colorectal cancer progresses after fluoropyrimidine-based combination chemotherapy. Both checkpoint regimens are clinically suitable. Which sequence best matches the current NICE pathway?

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Correct answer: COffer nivolumab-ipilimumab; reserve pembrolizumab for patients unable to receive it

NG151 recommends nivolumab plus ipilimumab after fluoropyrimidine-based combination chemotherapy in MSI-high or dMMR metastatic colorectal cancer. Pembrolizumab is recommended at this treatment position only when nivolumab-ipilimumab cannot be used. The alternatives either ignore molecular selection, invent an unappraised sequence or incorrectly restrict immunotherapy to untreated disease.

Reference: NICE NG151 colorectal cancer recommendations (Updated with 2025–2026 technology appraisals): https://www.nice.org.uk/guidance/ng151/chapter/Recommendations