Hundreds of people are set to benefit as NICE recommends acalabrutinib for newly diagnosed mantle cell lymphoma and chronic lymphocytic leukaemia
Mantle cell lymphoma
MCL is a rare and aggressive type of non-Hodgkin lymphoma. It is considered incurable with current treatments and often comes back. Many people are diagnosed when the disease is at an advanced stage and often are not well enough to have a stem cell transplant, which limits their options.
Clinical evidence showed that adding acalabrutinib to bendamustine and rituximab significantly increased the time before the condition worsened to 72.5 months, compared with 47.8 months for standard treatment alone. A patient expert involved in the evaluation told the independent committee about the shock and distress of receiving an incurable diagnosis. They explained that because many people have limited options once the disease progresses, having access to the best possible first-line treatment can be essential to extending time before relapse. The committee heard that having more first-line options available could help people feel more confident about their treatment journey.
Chronic lymphocytic leukaemia
NICE has also recommended acalabrutinib in combination with venetoclax, without obinutuzumab, as an option for adults with untreated chronic lymphocytic leukaemia (CLL) with around 440 set to benefit.
CLL is the most common type of leukaemia in adults in England. It usually progresses slowly but can have a significant physical and psychological impact on daily life. Patient experts told the independent committee that treatment preference is shaped by individual circumstances, including work, family life and the burden of frequent hospital visits.
Being diagnosed with mantle cell lymphoma or chronic lymphocytic leukaemia can have a profound physical and psychological impact on people and their families.
People tell us about the anxiety of waiting to see if a treatment will work, and what might come next. These recommendations give people further treatment options that can help extend the time before their cancer gets worse, while also fitting more easily around their daily life.
Helen Knight, director of medicines evaluation at NICE
Evidence from the AMPLIFY trial showed that acalabrutinib plus venetoclax improved progression-free survival and overall survival compared with standard chemoimmunotherapy.
Unlike some treatments for this type of cancer, acalabrutinib plus venetoclax is taken as a daily pill rather than by intravenous infusion, meaning it may be easier for some people to fit treatment around daily life and can mean fewer hospital trips. Clinical experts on the committee said it was generally well tolerated by people, which could make it a suitable option for a broader range of people, including older fitter patients.
I still remember the feeling of total shock when I was diagnosed, after 18 months of unexplained infections. At first, I was put on ‘watch and wait’, as I was too well to start treatment, and later, when treatment became necessary, at the age of 65, I made the difficult decision not to have a stem cell transplant. Instead, I had treatment with bendamustine and rituximab, followed by maintenance therapy. It hasn’t been straightforward – I’ve dealt with complications along the way, including problems with my immune system and my lungs. But 13 years on, I’m still here – living well, working as a trustee and playing the piano.
Ruth Lester, patient representative from Lymphoma Action, living with mantle cell lymphoma
Ruth continued: “That’s why this decision matters so much. It’s very encouraging to hear that a new and better tolerated treatment option has been recommended which should mean some MCL patients can enjoy a longer time with a better quality of life.”