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NICE draft guidance gives green light to Non-Hodgkin's lymphoma treatment

Today (Tuesday 24 May), the National Institute for Health and Care Excellence (NICE) has issued new draft guidance which recommends a treatment that can help delay the growth and spread of follicular non-Hodgkin's lymphoma. The draft guidance states that rituximab can be used as a first-line maintenance treatment1 in people with follicular non-Hodgkin's lymphoma that has responded to first-line induction therapy2 with rituximab in combination with chemotherapy.

Standard clinical practice for these patients, around 1600 in the UK3, is for doctors to wait for the cancer to grow again following successful induction therapy, before giving them further treatment. However the evidence presented to NICE's independent committee by the manufacturer, and advice from clinical specialists suggest that treating patients with rituximab maintenance after induction therapy can prevent the spread and growth of this cancer by 3-4 years4.

The manufacturer's economic modelling also convinced the committee that first-line rituximab maintenance treatment for these patients could be a cost-effective use of NHS resources compared with current clinical practice.

Professor Peter Littlejohns, Clinical and Public Health Director at NICE, said: “We are pleased to be able to provisionally recommend rituximab maintenance therapy as an option for the treatment of people with follicular non-Hodgkin's lymphoma that has responded to first-line induction therapy with rituximab in combination with chemotherapy.

“Using rituximab as a maintenance treatment after initial chemotherapy for follicular non-Hodgkin's lymphoma could be a valuable treatment option for hundreds of patients because no such maintenance treatment has so far been available at this stage of the disease. The evidence presented to the committee highlighted that it could keep a patient's cancer in remission for longer, after they have had chemotherapy.

“Alongside its proven clinical effectiveness, the Appraisal Committee has also established that rituximab first-line maintenance offers value for money for the NHS.”

In line with the NICE technology appraisals process this draft guidance is now with consultees, who have the opportunity to appeal against the proposed guidance NICE has not yet published final guidance for the NHS.

Ends

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References

1 A maintenance treatment is used to stop a cancer from returning following initial chemotherapy

2 Induction therapy is a type of treatment that is first given to a patient to reduce the size of the cancer or stop the cancer from progressing.

3 Roche Budget Impact Model, 2009 (Manufacturer's submission)

4 That is, 1 to 2 years sustained benefit after treatment has stopped.

Notes to editors

1. The final appraisal determination (FAD) is available from Tuesday 24 May 2011.

2. According to the draft guidance, the Appraisal Committee recommends rituximab maintenance therapy as an option for the treatment of people with follicular non-Hodgkin's lymphoma that has responded to first-line induction therapy with rituximab in combination with chemotherapy.

3. The clinical specialists advised the committee that they would expect rituximab maintenance to offer 3 to 4 years of progression-free survival (that is, 1 to 2 years sustained benefit after 2 years of treatment is completed).

4. The committee noted that the Incremental Cost Effectiveness Ratios (ICERs) for rituximab maintenance compared with observation in the manufacturer's base case and sensitivity analyses ranged from £17,349 to £27,397 per QALY gained for scenario analyses which varied the duration of the clinical effect of rituximab maintenance treatment to 28 months, 36 months or 48 months and assumed a conversion factor from progression-free survival to overall survival gain of 70%, 80% or 90%.

The Committee also noted that the ERG's exploratory sensitivity analyses, which assumed a duration of clinical benefit from rituximab maintenance treatment of 36 to 48 months (in line with clinical opinion), had ICERs ranging from £24,600 to £35,000 per QALY gained, depending on the conversion rate of progression free survival to overall survival gain assumed. The Committee was aware that the model did not include the utility associated with delaying chemotherapy, and that if it were included, it would decrease the ICER (that is, improve the cost effectiveness) to an estimate which would be considered as a cost-effective use of NHS resources.

5. In earlier draft guidance, published in March 2011, the Appraisal Committee was minded not to recommend rituximab for this indication unless further data was submitted in time for the next appraisal committee meeting in April 2011 to address specific uncertainties in the data.

6. 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.

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

8. 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 by intravenous infusion 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 throughits 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: 19 May 2011

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