NICE have today made their final recommendation on the use of brentuximab for treating Hodgkin’s Lymphoma. After assessing brentuximab for three different indications, the overall result is good news for patients, albeit with some more work to do.
Below, we go through the three indications for brentuximab, and explain the decision NICE has come to on each.
1. Relapsed or refractory disease after autologous stem cell transplant
NICE approved brentuximab for use for this indication – it will be routinely commissioned for NHS patients in England.
This is great news. For patients who relapse or have refractory disease after their stem cell transplant, there are essentially no other treatment options other than brentuximab. NHS patients in England have had access to brentuximab for the last four years via the old version of the Cancer Drugs Fund (CDF). Since the CDF was changed last year, all drugs that used to be included in it have had to be appraised by NICE – therefore if NICE had declined this indication, it would have been a huge step back. However, we are delighted that NICE have approved it, and patients can continue to have access to it in England, as they do in Wales, Scotland and Northern Ireland.
2. Increased risk of disease relapse or progression after autologous stem cell transplant
NICE did not approve this indication, so it will not be available to NHS patients.
This indication is for consolidation treatment after a patient has had a transplant and is at high risk of relapse. Unlike the other indications in this appraisal, brentuximab has not been used before in the UK for these patients. In addition, many clinicians think the use of brentuximab in this indication does not fit with current clinical practice. Overall, the clinical community does not regard NICE turning down this indication as being a significant issue for patients.
3. Relapsed or refractory disease after at least two previous therapies when autologous stem cell transplant or multi-agent chemotherapy is not an option
NICE recommended this indication should go into the new version of the Cancer Drugs Fund to gain more data, so access will remain for appropriate patients during this time.
Similarly to the first indication, brentuximab has been used for these patients in England for the past four years thanks to the old version of the CDF, and is already in use in Wales, Scotland and Northern Ireland. It is a very important drug for these patients, and provides a crucial treatment option that can act as a treatment “bridge” for patients until they are ready for a stem cell transplant. By entering the new version of the CDF, brentuximab will continue to be available to patients for the next 9-12 months while further data is gathered. Once this has been completed, NICE will make a final decision about whether it should be made available through routine commissioning. We are hopeful that they will do so, but obviously nothing is certain until the decision has been made.
Whilst we would have preferred this indication to be approved today, we are relieved that it was not declined – this would have been a very serious backward step. However, there is still work to be done – whilst the clinical community are unanimous about the importance of brentuximab for this indication, the case to NICE will need to be made very clearly in order to safeguard this treatment. The additional data set to be gathered in the next few months will help do this.
Overall, this announcement is good news for patients. We have avoided a very worrying scenario of Indication 1 or 3 being declined, and though there is more work to be done to get Indication 3 over the line, we are hopeful this will be the case in a year’s time.