Nilotinib and imatinib
This guidance updates and replaces recommendation 1.1 of NICE technology appraisal guidance 70 (published October 2003). The review and re-appraisal of imatinib for the treatment of chronic myeloid leukaemia (CML) has resulted in a change in the guidance. Specifically, standard-dose imatinib is recommended as an option for the first-line treatment of adults with chronic phase Philadelphia-chromosome-positive CML
NICE recommends nilotinib and standard-dose imatinib as possible treatments for some people with chronic myeloid leukaemia (see below).
Who can have nilotinib or imatinib?
You should be able to have nilotinib or standard-dose imatinib if:
- you have Philadelphia-chromosome-positive chronic myeloid leukaemia in the chronic phase and
- you have not had treatment for chronic myeloid leukaemia before.
NICE does not recommend dasatinib for people with chronic myeloid leukaemia in the chronic phase who have not had treatment for chronic myeloid leukaemia before.
Why has NICE said this?
NICE looks at how well treatments work, and also at how well they work in relation to how much they cost the NHS.
NICE recommended imatinib because it was cost-effective and has a longer-term record of safety and effectiveness than either dasatinib or nilotinib.
NICE found that dasatinib and nilotinib both provided a similar benefit and were both more effective than imatinib. But it could not recommend dasatinib because it costs more than imatinib or nilotinib and its high cost did not justify the benefits provided.
The recommendations in this guidance represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, health professionals are expected to take this guidance fully into account, alongside the individual needs, preferences and values of their patients. The application of the recommendations in this guidance is at the discretion of health professionals and their individual patients and do not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.
Commissioners and/or providers have a responsibility to provide the funding required to enable the guidance to be applied when individual health professionals and their patients wish to use it, in accordance with the NHS Constitution. They should do so in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities.