New draft guidance from the National Institute for Health and Clinical Excellence (NICE) recommends the use of Roche's MabThera (rituximab) in combination with a wide range of chemotherapy treatments for symptomatic stage III and IV follicular lymphoma.
The independent appraisal committee at NICE found that MabThera - used in combination with cyclophosphamide, vincristine and prednisolone (CVP), cyclophosphamide, doxorubicin, vincristine and prednisolone (CHOP), mitoxantrone, chlorambucil and prednisolone (MCP) and cyclophosphamide, doxorubicin, etoposide, prednisolone and interferon-a (CHVPi) chemotherapy - is both clinically and cost-effective as a first-line treatment.
NICE had previously recommended MabThera in combination with CVP for this indication, and this review of that appraisal now provisionally adds three other chemotherapy plus MabThera options.
Around 1,869 people in England and Wales have follicular lymphoma, the majority of whom present with advanced-stage disease (III-V), says NICE. Advanced follicular lymphoma is not curable and so the aim of disease management is to both increase life expectancy and health-related quality of life, it adds.
Four good-quality randomised clinical trials indicate that adding MabThera to CVP, CHOP, MCP and CHVPi can help patients live longer and improve their overall response to this disease when compared with chemotherapy alone, said Professor Carole Longson, director of NICE's Health Technology Evaluation Centre.
The appraisal committee members also heard evidence that patients require different treatment combinations depending on their age and overall health. "Some people are not fit enough to receive rituximab plus CVP, the most common form of treatment, and so other treatment options might be useful to them," she added.
"In addition, the economic analyses demonstrate that adding rituximab to the chemotherapy regimes is good value for money. The independent advisory committee concluded that the cost of rituximab in relation to how well it works in combination with CVP, CHOP, MCP and CHVPi is an effective use of NHS resources," said Prof Longson, who added: "this draft guidance is now open for consultation, and we welcome any feedback on our proposed recommendations."
This technology appraisal is a review of NICE technology appraisal 110, issued in September 2006. The previous guidance recommends the use of MabThera plus CVP as an option for first-line induction therapy for symptomatic stage III-IV follicular lymphoma. However, in 2008 the marketing authorisation was revised to allow the use of a wider range of chemotherapy regimens, which is the subject of this guidance review.
NICE has not yet published its final guidance to the NHS, which is expected next January.