Brentuximab vedotin for treating CD30-positive Hodgkin lymphoma - NICE TAG TA524

1.1 Brentuximab vedotin is recommended as an option for treating CD30‑positive Hodgkin lymphoma in adults with relapsed or refractory disease, only if:

• they have already had autologous stem cell transplant or

• they have already had at least 2 previous therapies when autologous stem cell transplant or multi-agent chemotherapy are not suitable and

• the company provides brentuximab vedotin according to the commercial arrangement.

1.2 These recommendations are not intended to affect treatment with brentuximab vedotin that was started in the NHS before this guidance was published. People having treatment outside these recommendations may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS clinician consider it appropriate to stop.

Why the committee made these recommendations (NICE technology appraisal guidance 446)

Hodgkin lymphoma is usually treated with chemotherapy, followed by stem cell transplant. Stem cell transplant gives people the best chance of a cure, so people who cannot have stem cell transplant have a high clinical unmet need. Brentuximab vedotin can be used as a 'bridging' treatment before stem cell transplant and, in some cases, as a curative treatment itself.

NICE technology appraisal guidance 446 recommended brentuximab vedotin as an option for treating adults with relapsed or refractory CD30‑positive Hodgkin lymphoma after autologous stem cell transplant. However, it was not recommended for adults who are at increased risk of disease relapse or progression after autologous stem cell transplant because the cost-effectiveness estimates were too high.

For adults with relapsed or refractory disease after at least 2 previous therapies, when autologous stem cell transplant or multi-agent chemotherapy is not suitable, the cost-effectiveness evidence was less clear. So brentuximab vedotin was recommended for use within the Cancer Drugs Fund in this population to collect data on its effectiveness in practice.

Why the committee made these recommendations (Cancer Drugs Fund review of technology appraisal guidance 446)

Data collected through the Cancer Drugs Fund on rates of stem cell transplant after treatment with brentuximab vedotin show that it improved rates of stem cell transplant compared with chemotherapy. Also, the updated cost-effectiveness estimates for brentuximab vedotin are lower than £20,000 per quality-adjusted life year gained. Because of this, brentuximab vedotin is recommended as an option for treating relapsed or refractory CD30‑positive Hodgkin lymphoma in adults, only if they have already had autologous stem cell transplant, or at least 2 previous therapies when autologous stem cell transplant or multi-agent chemotherapy are not suitable.

https://www.nice.org.uk/guidance/ta524