NICE backs NHS use of Takeda’s Adcetris for rare blood cancer

Takeda’s antibody-drug conjugate Adcetris can now be routinely available on the NHS to patients with a rare form of non-Hodgkin lymphoma (NHL), says NICE.

The final draft guidance from the agency means that around 190 patients in England with untreated systemic anaplastic large cell lymphoma (sALCL) are now eligible for access to Adcetris (brentuximab vedotin) as a combination therapy with chemotherapy.

Adcetris has a list price of £2,500 per 50 mg vial – equivalent to almost £48,000 for the six treatment cycles required by the average patient – but has been recommended by NICE after Takeda offered an undisclosed discount to the NHS.

At the moment patients with sALCL are generally offered first-line treatment with a chemotherapy regimen called CHOP – cyclophosphamide, doxorubicin, vincristine and prednisone (CHP) – but that is associated with severe side effects.

The new regimen subtracts the vincristine from the chemo – which is then known as CHP and is much easier to tolerate – and substitutes it with Adcetris.

As well as improving the tolerability, adding Takeda’s drug also boosts the efficacy of treatment, with one clinical trial showing that patients on Adcetris and CHP were almost twice as likely to survive beyond five years from diagnosis than patients on CHOP.

They are also more likely to have longer before their disease progresses than patients treated with CHOP.

Takeda says that sALCL is a rare and clinically aggressive cancer that can be hard to diagnose, so many patients already have late-stage disease when they are identified.

CHOP is widely acknowledged as a poor treatment option, so many patients are encouraged to enrol in clinical trials to improve their chances of survival.

“Not only can the disease and the current treatment options have a physical impact, but the psychological impact of being diagnosed with a rare cancer, with potentially poor outcomes, can be devastating,” commented Stephen Scowcroft of medical charity Lymphoma Action.

“That is why we are really pleased that newly diagnosed patients can now have access to an effective treatment, that can improve their quality of life and outcomes.”

Takeda originally sought approval of Adcetris in other rare NHL types that like sALCL come under the peripheral T-cell lymphoma (PTCL) category, but the European Commission said the evidence of efficacy in other types of PTCL was lacking.

The EU approved the drug for this indication in May, making Adcetris the first and only targeted therapy approved in first-line sALCL and the first new drug for the cancer in several decades.

Adcetris is already available through the NHS in England, Wales and Northern Ireland for sALCL adult patients with sALCL who have previously been treated with chemotherapy.

Originally developed by Seattle Genetics, the drug comprises a CD30-targeting antibody linked to a cell-killing drug (monomethyl auristatin E), and over the last nine years has been approved to treat a range of other types of lymphoma.