Pembrolizumab with carboplatin and paclitaxel for untreated primary advanced or recurrent endometrial cancer

Pembrolizumab with carboplatin and paclitaxel can be used, within its marketing authorisation, as an option for untreated primary advanced or recurrent endometrial cancer in adults. It can only be used if the company provides it according to the commercial arrangement .

Pembrolizumab with carboplatin and paclitaxel should be stopped after 2 years, or earlier if there is disease progression or unacceptable toxicity. What this means in practice Pembrolizumab with carboplatin and paclitaxel must be funded in the NHS in England for the condition and population in the recommendations, if it is considered the most suitable treatment option. It should be stopped after 2 years, or earlier if there is disease progression or unacceptable toxicity. Pembrolizumab with carboplatin and paclitaxel must be funded in England within 90 days of final publication of this guidance. There is enough evidence to show that pembrolizumab with carboplatin and paclitaxel provides benefits and value for money, so it can be used routinely across the NHS in this population. NICE has produced tools and resources to support the implementation of this guidance . People with untreated primary advanced or recurrent endometrial cancer usually have platinum-based chemotherapy, such as the combination carboplatin and paclitaxel. Clinical trial evidence shows that adding pembrolizumab to carboplatin and paclitaxel increases how long people have before their condition gets worse compared with carboplatin and paclitaxel alone. It is less certain how it affects how long people live because the clinical trial is still ongoing. The summary of product characteristics for pembrolizumab recommends that it is given for no longer than 2 years when it is used for untreated primary advanced or recurrent endometrial cancer. The cost-effectiveness estimates for pembrolizumab with carboplatin and paclitaxel are within the range that NICE considers an acceptable use of NHS resources. So, it can be used.

Pembrolizumab (Keytruda, MSD), in combination with carboplatin and paclitaxel, is indicated for 'the first-line treatment of primary advanced or recurrent endometrial carcinoma in adults'.

The dosage schedule is available in the summary of product characteristics for pembrolizumab .

The list price is £2,630.00 for a 25 mg per 1 ml concentrate for solution for infusion 4‑ml vial (excluding VAT; BNF online accessed July 2025).

The company has a commercial arrangement . This makes pembrolizumab available to the NHS with a discount. The size of the discount is commercial in confidence.

For information, the Carbon Reduction Plan for UK carbon emissions is published on MSD's webpage on responsibility .

Endometrial cancer starts in the lining of the uterus. Symptoms can include vaginal bleeding, pelvic pain, unintended weight loss, nausea and fatigue. Endometrial cancer has a significant effect on both life expectancy and quality of life. People with endometrial cancer that is advanced (has spread beyond the uterus) or recurrent (has come back after previous treatment) have a poor prognosis; only 15% of people diagnosed at stage 4 live for 5 or more years. The patient experts explained that a diagnosis of endometrial cancer is psychologically very challenging. The committee concluded that advanced or recurrent endometrial cancer has a devastating effect on life expectancy and quality of life.

Mismatch repair (MMR) is a system used by cells to correct the mutations in DNA that can cause cancer. Endometrial cancer can be mismatch repair deficient (dMMR; around 25% to 30% of cases) or proficient (pMMR; around 70% to 75% of cases). dMMR tumours are more likely to have high levels of mutation. The higher levels of mutation in dMMR tumours lead to more abnormal proteins being produced that are recognised by the immune system. dMMR endometrial cancer generally has a better prognosis than pMMR endometrial cancer. dMMR tumours also generally respond better to immunotherapy. The clinical experts explained that some pMMR tumours have biomarkers that are associated with a particularly poor prognosis and are unlikely to respond to treatment. But, some pMMR endometrial cancers can respond well to treatment. The committee concluded that, in general, dMMR endometrial cancer has a better prognosis and response to treatment than pMMR endometrial cancer.

For people with untreated advanced or recurrent endometrial cancer, the only routinely available treatment option is platinum-based chemotherapy. The patient experts explained that this can cause a sense of hopelessness because chemotherapy is not associated with curing endometrial cancer. They explained that people with endometrial cancer would be willing to accept worse side effects associated with adding immunotherapy to platinum-based chemotherapy if it prolonged response and if it potentially avoided the need for further treatment. The committee concluded that platinum-based chemotherapy (specifically, carboplatin and paclitaxel) was the appropriate comparator. It also concluded that there is an unmet need for more effective treatments for people with untreated advanced or recurrent endometrial cancer.

KEYNOTE‑868 is an ongoing multicentre, randomised, double-blind phase 3 trial comparing pembrolizumab with carboplatin and paclitaxel then maintenance pembrolizumab against carboplatin and paclitaxel then maintenance placebo. Initial treatment was for 18 weeks, followed by maintenance treatment for 84 weeks. Treatment continued until disease progression, unacceptable toxicity or the maximum treatment time was reached, which was approximately 24 months. The primary outcome of the trial was progression-free survival. Overall survival was a secondary outcome. The trial randomised 819 people with previously untreated advanced or recurrent endometrial cancer. A total of 408 people had pembrolizumab with carboplatin and paclitaxel and 411 had placebo with carboplatin and paclitaxel. Each intervention group was split into dMMR (222 people) and pMMR (597 people) subgroups. The results suggested that pembrolizumab with carboplatin and paclitaxel then pembrolizumab maintenance was significantly more effective at preventing progression or death than carboplatin and paclitaxel alone in both the dMMR subgroup and pMMR subgroups (the results from each subgroup are considered confidential by the company so cannot be reported here). Overall survival improved in each subgroup in people who had pembrolizumab with carboplatin and paclitaxel, but was not statistically significant in either subgroup. The committee noted that the relatively short follow-up time from the most recent data cut (the exact follow-up time is considered confidential by the company so cannot be reported here) may have affected the statistical significance of the overall-survival results. The committee also noted that nobody from the UK was included in the trial, but the clinical experts advised that this should not affect the generalisability of the results to NHS clinical practice. The clinical experts advised that stopping treatment after 2 years was appropriate because treatment response had occurred before this point. The committee concluded that pembrolizumab with carboplatin and paclitaxel is an effective treatment for improving progression-free survival in people with untreated advanced or recurrent endometrial cancer, but it was less certain how effective it was at prolonging overall survival. It also concluded that stopping pembrolizumab after 2 years was appropriate, in line with the clinical expert advice, summary of product characteristics and trial evidence.

The company retrospectively combined the dMMR and pMMR subgroups to produce an 'all-comer' population, which it used for most of its analyses. In the all-comer population, pembrolizumab with carboplatin and paclitaxel improved both progression-free survival (the exact improvement is considered confidential by the company so cannot be reported here) and overall survival (hazard ratio 0.74, 95% confidence interval 0.57 to 0.97). The EAG was concerned about combining results from both subgroups because the analysis was unplanned and retrospective. The company believed that the all-comer population was a better fit with the NICE scope and the marketing authorisation, and provided more statistical certainty because of the larger group size. The clinical experts advised that dMMR and pMMR endometrial cancer are treated differently in clinical practice because there are different subsequent treatments available for each subgroup. They advised that the groups have large differences in prognosis (see section 3.2 ) and that the 2 groups are likely to respond considerably differently to immunotherapy and should be considered separately. The committee agreed with the EAG and clinical experts that there are biological differences in how dMMR and pMMR endometrial cancer respond to treatment and different subsequent treatments are appropriate for each subgroup. These factors are likely to have an impact on both clinical- and cost-effectiveness estimates. It concluded that the pMMR and dMMR subgroups should be considered separately.

The company used a partitioned survival model with 3 health states: progression free, progressed disease and death. The committee agreed that the partitioned survival model is a standard approach for estimating the cost effectiveness of cancer drugs and is suitable for decision making. The company presented overall-survival curves for the all-comer population and the dMMR and pMMR subgroups. In each case, it assessed the suitability of the curves using visual and statistical methods and referred to experts to assess the clinical plausibility of the curves. For the dMMR subgroup, the company selected an exponential extrapolation for the carboplatin and paclitaxel only group and a log-logistic extrapolation for the pembrolizumab with carboplatin and paclitaxel group. For the pMMR subgroup, the company selected a gamma extrapolation for the carboplatin and paclitaxel only group and a log-logistic extrapolation for the pembrolizumab with carboplatin and paclitaxel group. After the first committee meeting, the EAG assessed the suitability of the company's choice of overall-survival extrapolations for each subgroup. The EAG agreed with the company's choice of overall-survival extrapolations in the dMMR subgroup. But in the pMMR subgroup, it thought a 1-knot hazard spline was more suitable for the carboplatin and paclitaxel group and a 1-knot normal spline was more suitable for the pembrolizumab with carboplatin and paclitaxel group. In response to the draft guidance consultation, the company stated that some people with pMMR endometrial cancer would have a very good long-term response to pembrolizumab with carboplatin and paclitaxel. It stated that this was better reflected by its preferred log-logistic curve than by the EAG's preferred 1-knot normal spline. The EAG noted that the 1-knot normal spline had a better fit to the observed trial data than the log-logistic model and had a stable hazard function in the long term. It also stated that the short follow up in the trial could not be used as evidence for a significant proportion of people having a long-term response to pembrolizumab with carboplatin and paclitaxel. So, the EAG stated that the company's preferred model for the pembrolizumab with carboplatin and paclitaxel group may overestimate survival in the long term. In response to the draft guidance consultation, the company stated that in the carboplatin and paclitaxel only group, the gamma model had the best statistical and visual fit and matched clinical expert opinion. The EAG noted that the 1-knot hazard spline had a good visual fit. The company and EAG noted that the preferred extrapolations for the carboplatin and paclitaxel only group were very similar. At the second committee meeting, the clinical expert stated that the EAG's preferred extrapolation for the pembrolizumab with carboplatin and paclitaxel group was most clinically plausible. They explained that it was difficult to assess the carboplatin and paclitaxel only extrapolations because they were so similar. The committee agreed with the clinical expert that the EAG's extrapolation for the pembrolizumab with carboplatin and paclitaxel group was most suitable. It agreed with the EAG that, without longer-term evidence, a more cautious interpretation of the evidence was most appropriate. The committee also thought that the EAG's extrapolation for the carboplatin and paclitaxel only group was most suitable, although it noted there was very little difference between the curves. The company presented progression-free survival curves for the dMMR subgroup in its submission. For the pembrolizumab with carboplatin and paclitaxel arm, it selected the generalised gamma extrapolation. The EAG preferred the log-logistic extrapolation for this arm. It explained that the log-logistic curve was more appropriate because the maturity of the data from the trial warranted more cautious extrapolation. The company noted that its experts considered both the EAG's and the company's selections plausible, but the experts' expectation of earlier and flatter plateauing aligned with the company's choice of generalised gamma. The company thought that the EAG's preferred extrapolation was too pessimistic. It highlighted that the clinical experts in NICE's technology appraisal guidance on dostarlimab with platinum-based chemotherapy for treating advanced or recurrent endometrial cancer with high microsatellite instability or mismatch repair deficiency (TA963) noted that risk of progression was very low after 5 years of progression-free survival. At the second committee meeting, the clinical expert suggested that both curves were plausible. For the carboplatin and paclitaxel only extrapolation, the company believed that all standard parametric curves had very poor fits to the trial progression-free survival data. So, it selected a 2‑piece gamma model with a 27‑week cut. The EAG preferred to use the generalised gamma extrapolation. It stated that, because there were limited differences in fit, the company's piecewise approach introduced additional model complexity without enough justification. It thought that, given the maturity of the long-term data, the generalised gamma model provided a more stable and interpretable long-term extrapolation. The company explained that the 2‑piece gamma model had a better visual fit to the data than the EAG's preferred extrapolation and was preferred by experts at an advisory board organised by the company. At the second committee meeting, the clinical expert explained that it was difficult to differentiate between the carboplatin and paclitaxel only extrapolations. The committee agreed with the EAG that it was reasonable to cautiously interpret the data because of the trial's limited follow up, and noted the clinical expert's opinion that both approaches were plausible. So, the committee concluded that the EAG's preferred extrapolations for the pembrolizumab with carboplatin and paclitaxel arm and the carboplatin and paclitaxel only arm were appropriate. The company presented progression-free survival curves for the pMMR subgroup in its original submission. For the pembrolizumab with carboplatin and paclitaxel arm the company selected a 2‑piece generalised gamma model with a 37‑week cut. For the same arm, the EAG suggested that spline models showed best fit to the observed trial data and hazards with 2‑knot splines had the best visual fit. It selected a 1‑knot hazard spline because it had a good visual fit to the trial data and provided a cautious interpretation of uncertain evidence from the trial. The company said that the EAG's preferred extrapolation for the pembrolizumab with carboplatin and paclitaxel arm had a poor visual fit to the observed data, especially in the tail. For the carboplatin and paclitaxel only group the company selected a 1‑knot odds spline model. It stated that it had an excellent visual fit and aligned with clinical experts' predictions. The EAG preferred a 2-knot hazard spline. It stated that spline models showed a strong visual fit to the trial data and the 2-knot hazard spline was the best fit to the observed data with a reasonable hazard function. The company suggested that the EAG's extrapolation for the carboplatin and paclitaxel only arm was overly optimistic, with long-term progression-free survival estimates higher than those made by its clinical experts. The company also noted that the curves for each treatment crossed because of the EAG's choice of extrapolations. It suggested that this was implausible because of the higher response rate and observed treatment effect in the pembrolizumab with carboplatin and paclitaxel arm. The EAG believed that the curve crossing was an artefact of uncertain long-term projections and did not undermine the validity of model in the observed trial data. At the second committee meeting, the NHS England Cancer Drugs Fund clinical lead (from here, Cancer Drugs Fund lead) agreed with the company that it was implausib

NICE's manual on health technology evaluations notes that, above a most plausible incremental cost-effectiveness ratio (ICER) of £20,000 per quality-adjusted life year (QALY) gained, judgements about the acceptability of a technology as an effective use of NHS resources will take into account the degree of certainty around the ICER. The committee noted that the survival estimates, especially overall survival, were uncertain because of the relatively short follow-up time of KEYNOTE‑868 (see section 3.4 ). But, it thought that much of this uncertainty was accounted for because it: • preferred conservative assumptions for: overall-survival modelling (see section 3.7 ) and progression-free-survival modelling in the dMMR (see section 3.8 ) and pMMR (see section 3.9 ) populations, and • applied treatment-effect waning (see section 3.12 ). The committee also noted the unmet need for people with untreated advanced or recurrent endometrial cancer (see section 3.1 ). So, the committee concluded that an acceptable ICER would be around the middle of the range NICE considers a cost-effective use of NHS resources (£20,000 to £30,000 per QALY gained). preferred conservative assumptions for: overall-survival modelling (see section 3.7 ) and progression-free-survival modelling in the dMMR (see section 3.8 ) and pMMR (see section 3.9 ) populations, and • overall-survival modelling (see section 3.7 ) and • progression-free-survival modelling in the dMMR (see section 3.8 ) and pMMR (see section 3.9 ) populations, and overall-survival modelling (see section 3.7 ) and progression-free-survival modelling in the dMMR (see section 3.8 ) and pMMR (see section 3.9 ) populations, and applied treatment-effect waning (see section 3.12 ). The committee also noted the unmet need for people with untreated advanced or recurrent endometrial cancer (see section 3.1 ). So, the committee concluded that an acceptable ICER would be around the middle of the range NICE considers a cost-effective use of NHS resources (£20,000 to £30,000 per QALY gained).

The committee's preference was for separate analyses for the dMMR and pMMR subgroups (see section 3.5 ). The committee's preferred assumptions for the dMMR subgroup were: • using a log-logistic extrapolation for the pembrolizumab with carboplatin and paclitaxel group and an exponential extrapolation for the carboplatin and paclitaxel only group to model overall survival (see section 3.7 ) • using a log-logistic extrapolation for the pembrolizumab with carboplatin and paclitaxel group and a generalised gamma extrapolation in the carboplatin and paclitaxel only group to model progression-free survival (see section 3.8 ). The committee's preferred assumptions for the pMMR subgroup were: • to model overall survival using a 1‑knot normal spline for the pembrolizumab with carboplatin and paclitaxel arm and 1‑knot hazard spline for the carboplatin and paclitaxel only arm (see section 3.7 ) • to model progression-free survival using: a 1‑knot hazard spline for the pembrolizumab with carboplatin and paclitaxel arm and a 2‑knot hazard spline in the carboplatin and paclitaxel only arm, with a cap so the effect is never higher than in the pembrolizumab with carboplatin and paclitaxel arm (see section 3.9 ). The committee's preferred assumptions that applied to both subgroups were: • using a starting age of 65.4 years (see section 3.10 ) • utility values derived from KEYNOTE‑158 for both the progression-free health state and the progressed-disease health state (see section 3.11 ) • treatment-effect waning from 5 to 7 years after starting treatment with pembrolizumab, applied to people whose cancer did not have a complete response to pembrolizumab (see section 3.12 ) • using the company's updated resource-use estimates (see section 3.13 ) • using the company's updated subsequent treatment mix (see section 3.14 ). using a log-logistic extrapolation for the pembrolizumab with carboplatin and paclitaxel group and an exponential extrapolation for the carboplatin and paclitaxel only group to model overall survival (see section 3.7 ) using a log-logistic extrapolation for the pembrolizumab with carboplatin and paclitaxel group and a generalised gamma extrapolation in the carboplatin and paclitaxel only group to model progression-free survival (see section 3.8 ). The committee's preferred assumptions for the pMMR subgroup were: to model overall survival using a 1‑knot normal spline for the pembrolizumab with carboplatin and paclitaxel arm and 1‑knot hazard spline for the carboplatin and paclitaxel only arm (see section 3.7 ) to model progression-free survival using: a 1‑knot hazard spline for the pembrolizumab with carboplatin and paclitaxel arm and a 2‑knot hazard spline in the carboplatin and paclitaxel only arm, with a cap so the effect is never higher than in the pembrolizumab with carboplatin and paclitaxel arm (see section 3.9 ). The committee's preferred assumptions that applied to both subgroups were: using a starting age of 65.4 years (see section 3.10 ) utility values derived from KEYNOTE‑158 for both the progression-free health state and the progressed-disease health state (see section 3.11 ) treatment-effect waning from 5 to 7 years after starting treatment with pembrolizumab, applied to people whose cancer did not have a complete response to pembrolizumab (see section 3.12 ) using the company's updated resource-use estimates (see section 3.13 ) using the company's updated subsequent treatment mix (see section 3.14 ).

Applying the committee's preferred assumptions to the dMMR population resulted in an ICER below the middle of the range NICE considers a cost-effective use of NHS resources (£20,000 to £30,000 per QALY gained). Applying the committee's preferred assumptions to the pMMR population also resulted in an ICER below the middle of the range NICE considers a cost-effective use of NHS resources. The exact ICERs cannot be reported here because they include confidential discounts for drugs included for the intervention and second-line treatments in the model.

The committee noted that endometrial cancer affects people with female reproductive organs. It also noted concerns raised by the company that: • incidence rates for endometrial cancer are higher among the Black ethnic group than the White ethnic group • people from the Black ethnic group are more likely than people from other ethnic groups to be: diagnosed with higher-risk, non-endometrioid endometrial cancer subtypes given a late-stage diagnosis of endometrial cancer • the diagnostic method for endometrial cancer (transvaginal ultrasound) is less reliable when fibroids are present and in high-risk, non-endometrioid endometrial cancer, both of which are more common in Black people. Race and sex are protected characteristics under the Equality Act 2010. The committee noted that these equalities issues could only be addressed by changes in diagnostics, which is not within the remit of this technology appraisal. Because its recommendation does not restrict access to treatment for some people over others, the committee thought these were not potential equalities issues that could be addressed by this appraisal. incidence rates for endometrial cancer are higher among the Black ethnic group than the White ethnic group people from the Black ethnic group are more likely than people from other ethnic groups to be: diagnosed with higher-risk, non-endometrioid endometrial cancer subtypes given a late-stage diagnosis of endometrial cancer • diagnosed with higher-risk, non-endometrioid endometrial cancer subtypes • given a late-stage diagnosis of endometrial cancer diagnosed with higher-risk, non-endometrioid endometrial cancer subtypes given a late-stage diagnosis of endometrial cancer the diagnostic method for endometrial cancer (transvaginal ultrasound) is less reliable when fibroids are present and in high-risk, non-endometrioid endometrial cancer, both of which are more common in Black people. Race and sex are protected characteristics under the Equality Act 2010. The committee noted that these equalities issues could only be addressed by changes in diagnostics, which is not within the remit of this technology appraisal. Because its recommendation does not restrict access to treatment for some people over others, the committee thought these were not potential equalities issues that could be addressed by this appraisal.

The committee discussed whether there were any uncaptured benefits of pembrolizumab with carboplatin and paclitaxel. It did not identify additional benefits of pembrolizumab with carboplatin and paclitaxel that had not already been captured in the economic modelling. So, the committee concluded that all the benefits of pembrolizumab with carboplatin and paclitaxel had been taken into account.

The committee noted that, when its preferred assumptions were applied, the cost-effectiveness estimates for both the dMMR and pMMR populations were within what the committee considered a cost-effective use of NHS resources (see section 3.17 ). So, pembrolizumab with carboplatin and paclitaxel is recommended for untreated primary advanced or recurrent endometrial cancer.

Section 7 of the National Institute for Health and Care Excellence (Constitution and Functions) and the Health and Social Care Information Centre (Functions) Regulations 2013 requires integrated care boards, NHS England and, with respect to their public health functions, local authorities to comply with the recommendations in this evaluation within 90 days of its date of publication.

Chapter 2 of Appraisal and funding of cancer drugs from July 2016 (including the new Cancer Drugs Fund) – A new deal for patients, taxpayers and industry states that for those drugs with a draft recommendation for routine commissioning, interim funding will be available (from the overall Cancer Drugs Fund budget) from the point of marketing authorisation, or from release of positive draft guidance, whichever is later. Interim funding will end 90 days after positive final guidance is published (or 30 days in the case of drugs with an Early Access to Medicines Scheme designation or cost comparison evaluation), at which point funding will switch to routine commissioning budgets. The NHS England Cancer Drugs Fund list provides up-to-date information on all cancer treatments recommended by NICE since 2016. This includes whether they have received a marketing authorisation and been launched in the UK.

The Welsh ministers have issued directions to the NHS in Wales on implementing NICE technology appraisal guidance. When a NICE technology appraisal guidance recommends the use of a drug or treatment, or other technology, the NHS in Wales must usually provide funding and resources for it within 60 days of the first publication of the final draft guidance.

When NICE recommends a treatment 'as an option', the NHS must make sure it is available within the period set out in the paragraphs above. This means that, if a patient has untreated primary advanced or recurrent endometrial cancer and the healthcare professional responsible for their care thinks that pembrolizumab with carboplatin and paclitaxel is the right treatment, it should be available for use, in line with NICE's recommendations.

Pembrolizumab with carboplatin and paclitaxel can be used, within its marketing authorisation, as an option for untreated primary advanced or recurrent endometrial cancer in adults. It can only be used if the company provides it according to the commercial arrangement .

Pembrolizumab with carboplatin and paclitaxel should be stopped after 2 years, or earlier if there is disease progression or unacceptable toxicity. What this means in practice Pembrolizumab with carboplatin and paclitaxel must be funded in the NHS in England for the condition and population in the recommendations, if it is considered the most suitable treatment option. It should be stopped after 2 years, or earlier if there is disease progression or unacceptable toxicity. Pembrolizumab with carboplatin and paclitaxel must be funded in England within 90 days of final publication of this guidance. There is enough evidence to show that pembrolizumab with carboplatin and paclitaxel provides benefits and value for money, so it can be used routinely across the NHS in this population. NICE has produced tools and resources to support the implementation of this guidance . People with untreated primary advanced or recurrent endometrial cancer usually have platinum-based chemotherapy, such as the combination carboplatin and paclitaxel. Clinical trial evidence shows that adding pembrolizumab to carboplatin and paclitaxel increases how long people have before their condition gets worse compared with carboplatin and paclitaxel alone. It is less certain how it affects how long people live because the clinical trial is still ongoing. The summary of product characteristics for pembrolizumab recommends that it is given for no longer than 2 years when it is used for untreated primary advanced or recurrent endometrial cancer. The cost-effectiveness estimates for pembrolizumab with carboplatin and paclitaxel are within the range that NICE considers an acceptable use of NHS resources. So, it can be used.

Pembrolizumab with carboplatin and paclitaxel can be used, within its marketing authorisation, as an option for untreated primary advanced or recurrent endometrial cancer in adults. It can only be used if the company provides it according to the commercial arrangement .

Pembrolizumab with carboplatin and paclitaxel should be stopped after 2 years, or earlier if there is disease progression or unacceptable toxicity. What this means in practice Pembrolizumab with carboplatin and paclitaxel must be funded in the NHS in England for the condition and population in the recommendations, if it is considered the most suitable treatment option. It should be stopped after 2 years, or earlier if there is disease progression or unacceptable toxicity. Pembrolizumab with carboplatin and paclitaxel must be funded in England within 90 days of final publication of this guidance. There is enough evidence to show that pembrolizumab with carboplatin and paclitaxel provides benefits and value for money, so it can be used routinely across the NHS in this population. NICE has produced tools and resources to support the implementation of this guidance . People with untreated primary advanced or recurrent endometrial cancer usually have platinum-based chemotherapy, such as the combination carboplatin and paclitaxel. Clinical trial evidence shows that adding pembrolizumab to carboplatin and paclitaxel increases how long people have before their condition gets worse compared with carboplatin and paclitaxel alone. It is less certain how it affects how long people live because the clinical trial is still ongoing. The summary of product characteristics for pembrolizumab recommends that it is given for no longer than 2 years when it is used for untreated primary advanced or recurrent endometrial cancer. The cost-effectiveness estimates for pembrolizumab with carboplatin and paclitaxel are within the range that NICE considers an acceptable use of NHS resources. So, it can be used.