NICE Recommends Rituximab For The First Line Treatment Of Follicular Lymphoma, UK

By: Leukemia News

NICE has issued guidance to the NHS in England in Wales recommending rituximab, within its licensed indications, (that is, in combination with cyclophosphamide, vincristine and prednisolone - or CVP) as an option for the treatment of patients with symptomatic stage III and IV follicular lymphoma who have previously been untreated.

Non-Hodgkin's lymphomas (NHLs), of which follicular lymphomas are one type, are a diverse group of tumours that affect the lymphatic system, part of the body's defense against infection. Follicular lymphoma is the most common type of NHL, and affects B cells, a type of white blood cell involved in fighting infections. Stage III disease involves lymph nodes on both sides of the diaphragm. In Stage IV, the disease is widespread throughout the body. Most follicular lymphomas present at Stage III or IV.

The aims of treatment are to achieve remission during relapse and to alleviate symptoms. As most patients don't have any symptoms in the early phase of the disease, initially general observation, referred to as 'watchful waiting', is usually used. As the disease progresses and symptoms occur, initial current treatment is started in the form of single-agent therapy, usually with an oral alkylating agent such as chlorambucil. Combination therapies CVP (cyclophosphamide, vincristine and prednisolone) and CHOP (cyclophosphamine, doxorubicin, vincristine and prednisolone) are also currently used as first-line treatments.

Rituximab is a genetically engineered monoclonal antibody that 'recognises' and sticks to a protein found on the surface of some B cells, both normal and cancerous. This 'labels' the B cells and they are then destroyed by the body's immune system. Once chemotherapy has finished, more normal B cells are produced to replace those destroyed. Rituximab is licensed as a treatment for previously untreated stage III and IV follicular lymphoma in combination with CVP.

Dr Gillian Leng, Implementation Systems Director and Executive Lead for the appraisal, said: "In 2002 NICE issued guidance recommending the use of rituximab as last-line treatment of stage III or IV follicular lymphoma. Today's guidance extends the use of this drug to cover first-line treatment, improves the options available to people with this form of cancer and sets clear standards for the NHS in England and Wales on how it should be used."

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About NICE

1. The National Institute for Health and Clinical Excellence (NICE) is the independent organisation responsible for providing national guidance on the promotion of good health and the prevention and treatment of ill health.

2. NICE produces guidance in three areas of health:
* public health - guidance on the promotion of good health and the prevention of ill health for those working in the NHS, local authorities and the wider public and voluntary sector
* health technologies - guidance on the use of new and existing medicines, treatments and procedures within the NHS
* clinical practice - guidance on the appropriate treatment and care of people with specific diseases and conditions within the NHS.

NICE is the independent organisation responsible for providing national guidance on the promotion of good health and the prevention and treatment of ill health.