Breakthrough treatment backed for non-Hodgkin lymphoma patients

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A breakthrough cancer treatment has been recommended for adults with some types of non-Hodgkin lymphoma.

The National Institute for Health and Care Excellence (Nice) has published final draft guidance recommending the CAR T-cell therapy, axicabtagene-ciloleucel, part of a new wave of personalised medicine which re-engineers a patient’s own immune cells to fight cancer.

The treatment, also known as Yescarta and manufactured by Kite, a Gilead company, will be made available as part of the Cancer Drugs Fund (CDF), giving eligible patients access to it while more data is collected.

The therapy is for adults with relapsed or refractory diffuse large B-cell lymphoma or primary mediastinal large B-cell lymphoma, two aggressive subtypes of non-Hodgkin lymphoma, and will be the first time they will be able to access a CAR-T therapy in the UK.

It will be offered to patients whose disease has not responded after two or more rounds of chemotherapy or relapsed after a stem cell transplant.

In many cases, these patients have run out of treatment options and are unlikely to survive the next six months.

CAR-T therapies such as axicabtagene-ciloleucel harness the immune system to detect and destroy cancer cells through a new process in which a patient’s blood is collected, re-engineered in a lab, and then returned to their body in a single intravenous infusion.

Approximately 200 patients each year in England will be eligible for the therapy, which will be available at seven hospitals as the service is rolled out across the country.

Meindert Boysen, director of the Centre for Health Technology Evaluation at Nice, said: “People with these aggressive subtypes of non-Hodgkin lymphoma often have very poor outcomes.

“Nice’s recommendation is exciting because it means that adults will have access to a CAR T-cell therapy through the Cancer Drugs Fund.

“It is great to see that NHS England is preparing to deliver CAR T-cell therapy as quickly as possible and we hope that people can start treatment soon.”

Nice’s initial draft guidance did not recommend axicabtagene-ciloleucel as the therapy was not considered cost-effective.

But further negotiations between NHS England and the company led to a commercial agreement offering axicabtagene-ciloleucel at a lower price.

After considering the evidence, the committee concluded that axicabtagene-ciloleucel for adults with large B-cell lymphoma or primary mediastinal large B-cell lymphoma, after two or more systemic therapies, can be offered through the CDF.

Nice said that although axicabtagene-ciloleucel is promising, there are still uncertainties around its long-term outcomes and potential side-effects, and further data collection will aid a future decision about funding the therapy routinely.

NHS England director of specialised commissioning John Stewart said: “As we prepare to publish the NHS’s long term plan, this constructive and fast-track negotiation shows how the NHS is leading from the front by ensuring patients in England are among the first in the world to benefit from this immensely promising treatment.”

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