First CAR T-cell therapy recommended for routine use on the NHS in England
- Eligible adult patients with relapsed or refractory diffuse large B-cell lymphoma (DLBCL) and primary mediastinal large B-cell lymphoma (PMBCL) who have received 2 or more systemic therapies will have long-term NHS access to this treatment -
26th JANUARY 2023, LONDON, UK – Gilead Sciences Ltd. and Kite, a Gilead company, today announced that the National Institute for Health and Care Excellence (NICE) has recommended Yescarta® ▼ (axicabtagene ciloleucel; axi-cel) for routine commissioning on the NHS in England for the treatment of some adults with certain forms of lymphoma. Specifically, patients with diffuse large B-cell lymphoma (DLBCL) and primary mediastinal large B-cell lymphoma (PMBCL) who have already been treated with 2 or more systemic therapies may be eligible for treatment. Through the Cancer Drugs Fund, in 2018, England was the first country in Europe to provide access to a chimeric antigen receptor (CAR) T-cell therapy to treat these blood cancers, and since then over 500 patients in England have received axi-cel.
Dr Graham Collins, Consultant Haematologist at Oxford University Hospitals NHS Foundation Trust said: “Since the earliest clinical trial data on CAR T-cell therapies were presented, there has been excitement in the clinical community about their potential to help fight cancer. Today’s news is encouraging as it shows that even in the real-world setting, these therapies are living up to their expectations for patients with aggressive forms of lymphoma. Importantly, it means some patients who have received prior treatment have the potential to face a different outlook on their prognosis.”
CAR T-cell therapy is an individualised treatment for patients that is currently licensed for people living with some types of advanced blood cancer. CAR T-cell therapy engineers a patient’s own immune cells (T-cells) to detect, target and destroy cancer cells.
Dr Véronique Walsh, Vice President and General Manager, Gilead Sciences UK & Ireland said: “We are pleased to announce that, moving forward, axi-cel will be routinely available in the third line setting for all eligible DLBCL and PMBCL patients on the NHS. This news comes at a time when new hospitals are preparing to deliver CAR T-cell therapies, and will mean that healthcare professionals in these centres will have this treatment as an important option for their patients.”
DLBCL and PMBCL are both aggressive forms of non-Hodgkin lymphoma. Around 14,200 cases of non-Hodgkin lymphoma are diagnosed in the UK each year, of which approximately 5,500 are diagnosed with DLBCL and 330 with PMBCL.[i],[ii],[iii] After initial chemotherapy, up to 45% of patients with DLBCL will require a second line treatment, which often involves high dose chemotherapy and a stem cell transplant.[iv] Of those who receive a transplant, about 50% will ultimately relapse.[v] This decision ensures that these patients in the third line setting will continue to have access to CAR T-cell therapy.
Overall, survival of DLBCL significantly lags behind the average for all blood cancers, with only 60% of people living with this aggressive form of cancer surviving for 5 years compared to 70% across blood cancers more generally.[vi],[vii]
Helen Rowntree, CEO at Blood Cancer UK said: “CAR-T therapies offer hope to people who are living with the most aggressive forms of blood cancer. For people living with diffuse large B-cell lymphoma, the risk of recurrence and uncertainty about which treatment options will be available to them can add distress at an already very difficult time. We’re pleased that this CAR T-cell therapy can be a viable option for certain blood cancer patients in the long term. It gives people who find themselves in this position more clarity about their treatment options.”
Helen continued “It also demonstrates the benefit of the NHS England’s Cancer Drugs Fund, which led to many accessing this drug in the period of time when NICE was gathering evidence and deliberating on its cost-effectiveness. All in all, it’s good news for people with blood cancer, however we know there’s more work to do, because still too many people are dying of blood cancer.”
[i] Cancer Research UK. What is non-Hodgkin lymphoma? Available at: https://www.cancerresearchuk.org/about-cancer/non-hodgkin-lymphoma/about. Last accessed: January 2023.
[ii] Cancer Research UK. Diffuse large B cell lymphoma. Available at: https://www.cancerresearchuk.org/about-cancer/non-hodgkin-lymphoma/types/diffuse-large-B-cell-lymphoma. Last accessed: January 2023.
[iii] Dabrowska-Iwanicka A, Walewski JA. Primary mediastinal large B-cell lymphoma. Curr Hematol Malig Rep. 2014 Sep;9(3):273-83. https://doi.org/10.1007/s11899-014-0219-0.
[iv] Chaganti, S., Illidge, T., Barrington, S., et al. Guidelines for the management of diffuse large B-cell lymphoma. Br J Haematol. 2016 174: 43-56. https://doi.org/10.1111/bjh.14136.
[v] Crump M, Neelapu SS, Farooq U, et al. Outcomes in refractory diffuse large B-cell lymphoma: results from the international SCHOLAR-1 study. Blood. 2017 Oct 19;130(16):1800-1808. https://doi.org/10.1182/blood-2017-03-769620.
[vi] Cancer Research UK. Survival. Available at: https://www.cancerresearchuk.org/about-cancer/non-hodgkin-lymphoma/survival#:~:text=Generally%20for%20people%20with%20DLBCL,or%20more%20after%20their%20diagnosis. Last accessed: January 2023.
[vii] Blood Cancer UK. Facts and information about blood cancer. Available at: https://bloodcancer.org.uk/news/blood-cancer-facts/#:~:text=Overall,%20the%20five-year%20survival,who%20doesn't%20have%20cancer. Last accessed: January 2023.