19 September 2018

NICE encourages further discussions on Kymriah for adult lymphoma

CAR-T is too expensive to recommend as a treatment for adults with lymphoma, NICE says in draft guidance today (19 September).

However, NICE does recognise that Novartis’ tisagenlecleucel-T, also known as Kymriah, has significant clinical benefits, and would welcome further discussions on its cost-effectiveness.

NICE’s independent technology appraisal committee considered tisagenlecleucel-T for adults who have relapsed or refractory diffuse large B-cell lymphoma after 2 or more lines of systemic therapy.

The committee will consider comments on the draft guidance, together with any new evidence, at its next meeting on 23 October 2018.

New era of treatments

This treatment is part of a new era of personalised T-Cell (CAR-T) therapies which are designed for each patient. It involves taking a patient’s white blood cells and reengineering them so they can recognise and attack cancer cells. Despite significant clinical benefits for adults with lymphoma, there is no data comparing tisagenlecleucel-T to salvage chemotherapy, the most common treatment currently used for this type of cancer.

This makes it difficult to determine the exact benefits of tisagenlecleucel-T and the committee concluded that in this case, tisagenlecleucel-T is not cost-effective for routine funding or use within the Cancer Drugs Fund (CDF).

There are also a number of side effects a person may experience from tisagenlecleucel-T and extensive monitoring by trained specialists is needed.

‘Further discussions welcomed’

Although the treatment could not be recommended at this time, NICE welcomes further discussions on tisagenlecleucel-T, Kymriah (Novartis), for the treatment of adults who have B-cell lymphoma.

Meindert Boysen, director of the Centre for Health Technology Evaluation at NICE, says: “We have seen promising results for CAR-T therapies in early trials and believe there is great potential for tisagenlecleucel-T to help people who have not responded to other forms of therapy.

“Although we could not recommend tisagenlecleucel-T for adults with lymphoma, we welcome further discussions around the cost-effectiveness of the treatment and engagement with stakeholders.”

The company had offered a confidential discount on the list price of £282,000, however, the cost-effectiveness estimates were still above the range that NICE considers an acceptable use of NHS resources.

Lymphomas are cancers of the lymphatic system. There were around 11,690 new cases of non-Hodgkin lymphoma (NHL) in England in 2015 with 4,688 of these being for diffuse large B-cell lymphoma.

Although we could not recommend tisagenlecleucel-T for adults with lymphoma, we welcome further discussions around the cost-effectiveness of the treatment and engagement with stakeholders

Meindert Boysen, director of the Centre for Health Technology Evaluation at NICE