1 Recommendation
1.1 Axicabtagene ciloleucel is recommended, within its marketing authorisation, as an option for treating relapsed or refractory diffuse large B-cell lymphoma or primary mediastinal large B-cell lymphoma in adults after 2 or more systemic therapies. It is recommended only if the company provides axicabtagene ciloleucel according to the commercial arrangement.
Why the committee made this recommendation
This appraisal reviews the additional evidence collected as part of the Cancer Drugs Fund managed access agreement for axicabtagene ciloleucel for treating relapsed or refractory diffuse large B-cell lymphoma or primary mediastinal large B-cell lymphoma in adults after 2 or more systemic therapies (NICE technology appraisal guidance 559).
There is no standard treatment for relapsed or refractory diffuse large B-cell lymphoma or primary mediastinal large B-cell lymphoma after 2 or more systemic therapies. Best supportive care is used and usually includes salvage chemotherapy. Axicabtagene ciloleucel is a chimeric antigen receptor (CAR) T‑cell therapy (also called CAR‑T therapy). It uses the patient's own immune cells that have been modified to attach to and kill cancer cells.
The new evidence includes data from a clinical trial and from people having axicabtagene ciloleucel in the NHS while it was available in the Cancer Drugs Fund. It suggests that people having axicabtagene ciloleucel live longer than people having salvage chemotherapy and have longer before their condition gets worse.
Axicabtagene ciloleucel meets NICE's criteria to be considered a life-extending treatment at the end of life. Taking this into account, the cost-effectiveness estimates for axicabtagene ciloleucel are within what NICE considers an acceptable use of NHS resources. So, axicabtagene ciloleucel is recommended for routine use in the NHS.