Treatments update
New treatments for lymphoma are being developed all the time. To be used in the UK, they have to be approved by an independent organisation who review clinical and cost effectiveness. This is called a Health Technology Assessment (HTA).
Several HTA decisions have been published in the last few weeks. Information in this article was correct at the time of going to print.
Brexucabtagene autoleucel for mantle cell lymphoma
The National Institute for Health and Care Excellence (NICE) has not recommendedthe use of brexucabtagene autoleucel (brexu-cel) for treating relapsed or refractory mantle cell lymphoma after two or more lines of systemic treatment.
Brexu-cel, also known by the brand name Tecartus, is a CAR-T cell therapy, a type of treatment that uses cells from your own immune system to fight lymphoma. It has been available as a treatment for relapsed or refractory mantle cell lymphoma via the Cancer Drug Fund.
Lymphoma Action has worked with Anthony Nolan and Blood Cancer UK to submit a formal appeal against this decision as joint stakeholders in the NICE appraisal process. We are currently awaiting news on the appeal and will continue to provide updates as soon as they become available. Whilst we are not sure how long the appeal process will take at this stage, it is important to remember that the decision is not final and that access to brexu-cel will not be affected until the appeal is decided
Epcoritamab for follicular lymphoma
NICE has published draft guidance recommending the use of epcoritamab as an option for treating follicular lymphoma that has relapsed or is refractory after two or more systemic (whole body) treatments. Epcoritamab can be used as a treatment in this way for a maximum of three years.
Epcoritamab is a bispecific antibody, which is a type of immunotherapy drug. Bispecific antibodies work by attaching to two targets, one on the surface of lymphoma cells and one on the surface of T cells (part of the immune system). This means that cells of the immune system come into direct contact with the lymphoma cells, leading to activation of the T cells which in turn kill the lymphoma cells.
NICE has made this decision because indirect comparisons suggest that epcoritamab is likely to increase how long people have before their condition gets worse and how long people live compared with current treatment. In addition, it offers a treatment option with a simpler administration as it can be given subcutaneously (as an injection under the skin).
Acalabrutinib for mantle cell lymphoma
NICE has published draft guidance not recommending treatment with acalabrutinib plus bendamustine and rituximab for untreated mantle cell lymphoma in adults who are not eligible for an autologous stem cell transplant.
Acalabrutinib is a BTK inhibitor. BTK inhibitors block a protein called Bruton’s tyrosine kinase (BTK). BTK plays a crucial role in B cell development.
NICE has made this decision because there is currently not enough evidence to determine if acalabrutinib plus bendamustine and rituximab offers value for money in this population. At this stage, this is only draft guidance and there will now be a period of consultation. Lymphoma Action will comment on this decision to ensure the patient’s perspective is heard by the committee. We will provide an update once the final decision is made.
Acalabrutinib for chronic lymphocytic leukaemia (CLL)
The Scottish Medicines Consortium (SMC) has approved the use of acalabrutinib in combination with venetoclax for the treatment of adults with previously untreated CLL.
Acalabrutinib is a type of targeted drug called a Bruton’s tyrosine kinase (BTK) inhibitor.
Acalabrutinib offers an additional treatment choice for people with CLL in Scotland.
Pirtobrutinib for CLL
NICE has published draft guidance recommending pirtobrutinib as an option for treating relapsed or refractory CLL in adults who have previously had a BTK inhibitor. This treatment is only recommended for use if retreatment with a covalent BTK inhibitor is not clinically appropriate.
Pirtobrutinib is a type of targeted drug called a noncovalent inhibitor of BTK. Currently available covalent BTK inhibitors bind to the BTK protein permanently. As a noncovalent BTK inhibitor, pirtobrutinib binds to the BTK protein in a different, reversible, way.
This decision adds an additional treatment choice for relapsed or refractory CLL.
Stay up-to-date on all future lymphoma HTA decisions and drug approvals in the news section of our website.
You can find out more about drug development, approval and funding, including how Lymphoma Action takes part in HTAs, at lymphoma-action.org.uk/DrugDevelopment
