Patients with aggressive non-Hodgkin's lymphoma should be offered rituximab, NICE recommends
Rituximab (MabThera) in combination with cyclophosphamide, doxorubicin, vincristine and prednisolone (CHOP) should be used first-line for the treatment of aggressive non-Hodgkin's lymphoma, according to the National Institute for Clinical Excellence.
In guidance issued this week, NICE recommends that patients with CD20-positive
diffuse large-B-cell lymphoma that is at stage 2, 3 or 4 and who are
candidates for CHOP therapy should also be offered rituximab. Patients
who cannot have CHOP therapy should not receive rituximab and patients
with stage 1 disease should only receive rituximab as part of a clinical
trial. NICE also recommends that a lymphoma specialist supervises patients’ treatment
with rituximab.
NICE estimates that the guidance will increase National Health Service
treatment costs by between £9.1m and £17.2m. “However,
because the number of cases of diffuse large-B-cell lymphoma is increasing,
this annual cost increase could rise to an upper estimate of £27.3m
by 2007,” NICE says.
Rituximab is a monoclonal antibody that targets the CD20 surface marker,
which is expressed on almost all B-cell lymphomas. The NICE guidance
says that rituximab probably induces the death of CD20-positive cells
by antibody-directed cytotoxicity, complement-dependent cytotoxicity
and the induction of apoptosis. It also appears to sensitise
cells to the action of conventional cytotoxic drugs.
The guidance, which is available in full via the NICE website,
will be reviewed in August 2006. |
