Epcoritamab is recommended as an option for treating relapsed or refractory diffuse large B-cell lymphoma (DLBCL) in adults after 2 or more systemic treatments, only if:
they have had polatuzumab vedotin, or if polatuzumab vedotin is contraindicated or not tolerated, and
the company provides epcoritamab according to the commercial arrangement.
This recommendation is not intended to affect treatment with epcoritamab 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
Usual treatment for DLBCL after 2 or more treatments is rituximab-based chemoimmunotherapy, polatuzumab vedotin with bendamustine plus rituximab (polatuzumab‑BR), or axicabtagene ciloleucel. People have rituximab-based chemoimmunotherapy or axicabtagene ciloleucel if they have already had polatuzumab vedotin.
Epcoritamab has not been directly compared with usual treatment in a clinical trial. An indirect comparison suggests that people having epcoritamab live for longer than people having rituximab-based chemoimmunotherapy, but the results are uncertain. It is not clear from indirect comparisons if people having epcoritamab live longer or have longer before their cancer gets worse than people having polatuzumab‑BR or axicabtagene ciloleucel.
The most likely cost-effectiveness estimates for epcoritamab compared with rituximab-based chemoimmunotherapy and axicabtagene ciloleucel are within what NICE normally considers an acceptable use of NHS resources. Because of their similar clinical effectiveness, only the difference in cost between epcoritamab and polatuzumab‑BR was considered, and epcoritamab is more expensive. So epcoritamab is recommended, but only for people who have had treatment containing polatuzumab vedotin, or if polatuzumab vedotin is contraindicated or not tolerated.