A NICE technology appraisal has concluded that pembrolizumab (Keytruda) is not recommended for treating relapsed or refractory classical Hodgkin lymphoma in adults who have had autologous stem cell transplant and brentuximab vedotin.
However, pembrolizumab is recommended for use within the Cancer Drugs Fund as an option for treating relapsed or refractory classical Hodgkin lymphoma in adults who have had brentuximab vedotin and cannot have autologous stem cell transplant, only if pembrolizumab is stopped after two years of treatment or earlier if the patient receives a stem cell transplant or the disease progresses.
The committee acknowledged that the evidence suggests pembrolizumab is effective for relapsed or refractory classical Hodgkin lymphoma in people who have had brentuximab vedotin and autologous stem cell transplant (population 1). However, it said that there is uncertainty about the size of the effect.
A requested cost-comparison of pembrolizumab versus nivolumab for this population was not provided by the company and the committee expressed concerns about the model that was provided.
The committee concluded that there was “insufficient justification for recommending pembrolizumab as a cost-effective use of NHS resources” in this population.
Because of the high unmet need for therapies to treat patients who have had brentuximab vedotin but cannot have autologous stem cell transplant (population 2), the committee determined that “it is plausible that pembrolizumab could be cost effective in this population”. The treatment is, therefore, recommended for use within the Cancer Drugs Fund for this population.