NICE has approved lenalidomide with rituximab as an option for previously treated follicular lymphoma (grade 1 to 3A) in adults.
Lenalidomide is the first approved targeted treatment for follicular lymphoma that is not an anti‑CD20 antibody. Lenalidomide is taken orally, and when used with rituximab is a chemotherapy-free combination.
The evidence for lenalidomide with rituximab came from the phase 3 multicentre randomised controlled AUGMENT trial that used rituximab monotherapy as the comparator. In the absence of direct comparative evidence of lenalidomide plus rituximab compared with rituximab plus CHOP (R‑CHOP) or rituximab plus CVP (R‑CVP), the company provided a matching-adjusted indirect comparison.
The matching-adjusted indirect comparison showed an improvement in progression-free survival (PFS) for lenalidomide with rituximab compared with R‑CHOP and R‑CVP. It also showed an improvement in overall survival (OS) for lenalidomide with rituximab compared with R‑CHOP and R‑CVP. Median PFS and OS could not be estimated because the follow-up data were immature.
While lenalidomide with rituximab costs more than rituximab with chemotherapy, the cost-effectiveness estimate is within the range that NICE normally considers an acceptable use of NHS resources.
