Adcetris cleared by NICE in aggressive blood cancer

NICE has recommended regular NHS funding for Takeda’s Adcetris  in an aggressive type of non-Hodgkin lymphoma after the company submitted further data to support its case.

In final draft guidance, NICE said Adcetris (brentuximab vedotin) can be funded in relapsed or refractory systemic anaplastic large cell lymphoma.

NICE had initially rejected funding for this drug in this use, but has changed its mind after the manufacturer submitted further data analyses.

However the cost-effectiveness body said the drug should only be used in less sick patients, based on the Eastern Co-operative Oncology Group (ECOG) assessment scale.

The drug is only cost-effective in patients graded as 0 or 1 on the ECOG scale, meaning they are still able to walk and carry out light activity. Grade 5 on the ECOG scale is death.

As is usually the case, Takeda has agreed a confidential discount for the drug, which has been reimbursed in this indication by the Cancer Drugs Fund (CDF) since April 2013.

NICE is nearly at the end of a backlog of assessments of drugs paid for by the CDF, and nearly all have received regular NHS funding.

Adcetris is commonly used as a salvage therapy after failure of at least one previous regimen. A NICE committee heard from clinical experts who said the drug can be used as a first-line salvage therapy before either autologous or allogeneic stem cell transplant or as a first salvage therapy without stem cell transplant.

It will be most likely used instead of salvage chemotherapy after failure of an initial round of chemo such as CHOP, offering fewer side-effects.

However Adcetris has been approved on the basis of a mid-stage trial and there is therefore uncertainty over progression-free and overall survival benefits.

But NICE accepted the antibody-drug conjugate could extend patients’ lives by years compared with chemotherapy – depending on number-crunching methods Adcetris increases progression free survival by 4.6 or 2.9 years, and overall survival by 8.3 years or 6.8 years.

NICE calculated that Adcetris will likely cost below £30,000 per Quality Adjusted Life Year, its upper  threshold in normal situations, and is therefore a cost-effective use of NHS resources.

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