‘Chemotherapy-free’ treatment for lymphoma made available for NHS use in England

Cancer Research UK

follicular_lymphoma_bone_marrow.jpg

Follicular lymphoma in bone marrow

Folliular lymphoma in the bone marrow. Credit: Flickr/CC BY 2.0

A new ‘chemotherapy-free' combination treatment has been made available for some adults with a type of non-Hodgkin lymphoma.  

The latest decision by the National Institute for Health and Care Excellence (NICE) means that lenalidomide (Revlimid) with rituximab will now be an option for some people with follicular lymphoma after initial treatment.  

Around 2,500 people are diagnosed with follicular lymphoma in the UK each year. 

Rose Gray, policy manager at Cancer Research UK said the decision will be “welcome news for people affected by this type of blood cancer.” 

How the drug works 

The combination treatment will be made available for people with follicular lymphoma whose cancer has either come back after treatment, or whose cancer hasn’t responded to initial treatment.  

Lenalidomide is already used to treat myeloma and other blood disorders. It works by interfering with a whole range of cellular processes, including chemical signals that stimulate cells to grow and divide.  

To treat follicular lymphoma, lenalidomide will be used in combination with the targeted cancer drug rituximab.  

Rituximab is currently used in conjunction with chemotherapy to treat this group of patients. But around 1 in 5 patients relapse within 2 years of treatment, according to NICE.  

A chemotherapy-free option 

The clinical trial compared the new combination of lenalidomide and rituximab to rituximab alone.

Trial results show that adding lenalidomide increases the time before the disease spreads (34.9 months vs 13.8 months, according to data provided to NICE).

And while the trial didn’t compare the lenalidomide combination to rituximab and chemotherapy, indirect comparisons suggest that the lenalidomide combination would improve survival compared to the chemotherapy-containing option.

Patients told NICE that a chemotherapy-free option would be welcome, as it could improve their quality of life.   

“It not only offers patients a chemotherapy-free treatment option, but it also benefits those whose disease has become resistant to chemotherapy” – Meindert Boysen, director of the Centre for Health Technology Evaluation at NICE 

Boysen added that “importantly, patients have also been seen to overcome previous resistance to rituximab when it’s taken with lenalidomide.”

Clinicians told NICE it's still not entirely clear how much longer patients might survive taking lenalidomide and rituximab compared to existing treatments. But based on the clinical trial results, NICE were confident that lenalidomide with rituximab would be a cost-effective use of NHS resources.

Gray said it was great that “NICE, NHS England and the manufacturer have been able to work together to ensure the NHS in England can provide this new treatment option quickly to patients.”

NICE decisions are usually adopted in Wales and Northern Ireland as well as England, so the decision is likely to affect patients in all 3 nations. Scotland has a separate process for reviewing which drugs should be available on the NHS. 

References

NICE (2020) Lenalidomide with rituximab for previously treated follicular lymphoma [ID1374]