NICE issues guidance on cutting-edge treatment for lymphoma
NHS patients are to be among the first in the world to be offered access to a cutting-edge cancer treatment after NICE recommended its use.
NHS clinicians in England will be able to consider the treatment for some patients with a form of lymphoma, a cancer that attacks the immune system. The personalised treatment, Tecartus also known as autologous anti-CD19-transduced CD3+, is a CAR-T therapy which uses the patient’s white blood cells which are then reengineered in a laboratory so they can recognise and attack cancer cells before being infused back into the patient.
New NICE guidance says the treatment can be considered for those with relapsed or refractory mantle cell lymphoma, who must previously have had a drug called Bruton’s tyrosine kinase (BTK) inhibitor, such as ibrutinib.
NICE has agreed a managed access agreement, via the Cancer Drugs Fund (CDF), with manufacturer Kite – a Gilead company – so more data can be collected while patients can access the treatment. A confidential discount for use of the therapy was agreed by NHS England and Kite.
There is no standard treatment for adults, who are usually in their 70s, with relapsed or refractory mantle cell lymphoma after a BTK inhibitor. A combination of rituximab, bendamustine and cytarabine (R BAC) is the most common treatment option. Around 100 patients each year could be treated with this CAR-T therapy.
Evidence from a study of Tecartus, seen by NICE’s independent appraisal committee, suggests that people being treated with the CAR-T therapy may live for longer and have more time before their disease relapses.
However, there is not enough evidence to tell if lymphoma patients having the CAR-T therapy can be cured, which is why the NICE committee has asked for further data to be collected on progression-free survival, overall survival, and the age when treatment starts. This will help to reduce the uncertainty in the evidence while the treatment is used on NHS patients.
The NHS has ten providers around the country which will be able to offer this treatment option. Many parts of the country continue to experience pressures on critical care services, that are required for the administration of a CAR T therapy. With the recommendation by NICE, clinicians can consider Tecartus as an available treatment option for eligible NHS patients at the earliest opportunity. This may require patients to travel outside their locality to receive this one-time treatment.
Sir Simon Stevens, NHS chief executive, said: “It is great news that more people with lymphoma will have access to an innovative new CAR-T cancer therapy thanks to our Cancer Drugs Fund, addressing a particular need for people with mantle cell lymphoma. Despite the pressures of the pandemic, the NHS continues to place effective, innovative treatments into the hands of clinicians for the benefit of the patients we treat.”
The final draft guidance is published on nice.org.uk and consultees and commentators can appeal the recommendation of the committee until Tuesday 2 February 2021.
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