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NICE draft guidance recommends maintenance treatment for follicular non-Hodgkin's lymphoma

The National Institute for Health and Care Excellence (NICE) has today (3 December) issued preliminary draft guidance recommending the use of rituximab (MabThera, Roche Products) as a first-line maintenance treatment for certain patients with advanced follicular non-Hodgkin's lymphoma. This draft recommendation, which has been issued for consultation today, is based on evidence suggesting the drug could significantly help to delay the growth and spread of the cancer.

Professor Peter Littlejohns, Clinical and Public Health Director at NICE, said: "A maintenance treatment is used to stop a cancer from returning following initial chemotherapy. For follicular non-Hodgkin's lymphoma, no such maintenance treatment has so far been available and therefore rituximab could be a valuable treatment option for patients with this type of cancer. The evidence highlighted that it could keep a patient's cancer in remission after they have had chemotherapy and therefore delay the need for further chemotherapy. This should mean that patients have fewer chemotherapy-associated side effects long-term and so improve their quality of life.

"However, the evidence submitted by the manufacturer did include some uncertainties, mostly around the extent to which rituximab can extend a patient's life expectancy and the impact of this assumption on its cost-effectiveness. While the committee felt that the drug is likely to be an appropriate use of NHS resources, it expects that the manufacturer will confirm this by providing further, more specific, information. We expect to receive this in good time for the data to be independently analysed ahead of a second committee meeting scheduled for February next year."

NICE's preliminary guidance is now available for public consultation until 7 January 2011. Comments can be made via the NICE website. Any feedback received during this consultation will be considered by the committee and, following this meeting, the next version of draft guidance will be issued.

Final guidance for rituximab for the first-line maintenance treatment of follicular non-Hodgkin's lymphoma is expected to be published next year. Until then, NHS bodies should make decisions locally on the funding of specific treatments.

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Notes to Editors

1. The Appraisal Consultation Document (ACD) is available to view at: http://guidance.nice.org.uk/TA/Wave19/59 (from Friday 3 December 2010).

2. According to the draft guidance, rituximab is recommended for the first-line maintenance treatment of people with advanced follicular non-Hodgkin's lymphoma that has responded to first-line induction therapy with rituximab in combination with chemotherapy

3. In the draft guidance, the Appraisal Committee expects that the manufacturer addresses the remaining uncertainties in their analysis and provides a revised cost-effectiveness analysis:

  • For people who are 60 to 65 years (the age at which most people are first treated in the UK) at the start of treatment, and
  • In which the duration of clinical benefit from rituximab maintenance treatment is 3 to 4 years, and
  • In which the extent that progression-free survival translates into overall survival gain is informed by the best available evidence, which could include patient registries and prospective observational data. Analyses should be presented for a range of plausible values, from 50% to 100%, and
  • In which utility gains associated with delaying the need for chemotherapy after relapse are included.

4. Non-Hodgkin's lymphoma is a cancer of the lymphatic system. This system is spread throughout the body and helps to circulate white blood cells (lymphocytes). Follicular non Hodgkin's lymphoma affects a type of white blood cell called B-cell lymphocytes. This type of cancer makes these cells grow and divide abnormally, creating tumours and weakening the immune system. The term ‘follicular' means that the cancer cells are grouped together rather than being spread out.

5. Current clinical practice for managing follicular non-Hodgkin's lymphoma that has responded to first-line induction treatment with chemotherapy involves ‘observation' or ‘watchful waiting'. This is when doctors wait until the cancer begins to grow again before giving patients more treatment.

6. Rituximab works by targeting a protein called CD-20 that is found on B-cell lymphocytes. The drug kills these cells allowing normal white blood cells to grow and replace those destroyed. It is given intravenously through a drip once every two months.

About NICE

1. The National Institute for Health and Care Excellence (NICE) is the independent organisation responsible for providing national guidance and standards on the promotion of good health and the prevention and treatment of ill health

2. NICE produces guidance in three areas of health:

  • public health - guidance on the promotion of good health and the prevention of ill health for those working in the NHS, local authorities and the wider public and voluntary sector
  • health technologies - guidance on the use of new and existing medicines, treatments, medical technologies (including devices and diagnostics) and procedures within the NHS
  • clinical practice - guidance on the appropriate treatment and care of people with specific diseases and conditions within the NHS.

3. NICE produces standards for patient care:

  • quality standards - these reflect the very best in high quality patient care, to help healthcare practitioners and commissioners of care deliver excellent services
  • Quality and Outcomes Framework - NICE develops the clinical and health improvement indicators in the QOF, the Department of Health scheme which rewards GPs for how well they care for patients

4. NICE provides advice and support on putting NICE guidance and standards into practice through its implementation programme, and it collates and accredits high quality health guidance, research and information to help health professionals deliver the best patient care through NHS Evidence.

This page was last updated: 03 December 2010

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Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.