Polatuzumab vedotin in combination for untreated diffuse large B-cell lymphoma

1.1 Polatuzumab vedotin with rituximab, cyclophosphamide, doxorubicin and prednisolone (R‑CHP) is recommended for untreated diffuse large B-cell lymphoma (DLBCL) in adults, only if

1.2 This recommendation is not intended to affect treatment with polatuzumab vedotin with R-CHP that was started in the NHS before this guidance was published. People having treatment outside this recommendation may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS clinician consider it appropriate to stop.

Why the committee made these recommendations

Standard treatment for untreated DLBCL is rituximab, cyclophosphamide, doxorubicin, vincristine and prednisolone (R‑CHOP). The company only provided evidence for polatuzumab vedotin with R-CHP for people with an IPI score of 2 to 5. This is narrower than polatuzumab vedotin's marketing authorisation, but clinical experts advised this is how it would be used in clinical practice.

Clinical evidence suggests that people with an IPI score of 2 to 5 having polatuzumab vedotin with R‑CHP have more time before their cancer gets worse than people having R‑CHOP alone. It is not clear if polatuzumab vedotin with R‑CHP increases how long people live compared with R‑CHOP.

The cost-effectiveness estimates for polatuzumab vedotin with R‑CHP are likely to be within what NICE considers an acceptable use of NHS resources. So, polatuzumab vedotin with R-CHP is recommended for people with an IPI score of 2 to 5.