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Draft guidance consultation

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1 Recommendations

1.1

Glofitamab plus gemcitabine and oxaliplatin should not be used to treat relapsed or refractory diffuse large B-cell lymphoma not otherwise specified in adults who are not eligible for autologous stem cell transplant.

1.2

This recommendation is not intended to affect treatment with glofitamab plus gemcitabine and oxaliplatin that was started in the NHS before this guidance was published. People having treatment outside this recommendation may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS healthcare professional consider it appropriate to stop.

What this means in practice

Glofitamab plus gemcitabine and oxaliplatin is not required to be funded in the NHS in England to treat relapsed or refractory diffuse large B-cell lymphoma not otherwise specified in adults who are not eligible for autologous stem cell transplant. It should not be used routinely in the NHS in England.

This is because there is not enough evidence to determine whether glofitamab with gemcitabine and oxaliplatin is value for money in this population.

Why the committee made these recommendations

Usual treatment for relapsed or refractory diffuse large B-cell lymphoma not otherwise specified in people who cannot have an autologous stem cell transplant is rituximab with gemcitabine and oxaliplatin (R-GemOx) or polatuzumab vedotin with rituximab and bendamustine (Pola-BR).

Clinical trial evidence shows that glofitamab plus gemcitabine and oxaliplatin increases how long people have before their cancer gets worse compared with R-GemOx. But there is uncertainty about how long people live after having glofitamab plus gemcitabine and oxaliplatin.

Glofitamab plus gemcitabine and oxaliplatin has not been directly compared in a clinical trial with Pola-BR. Indirect comparisons suggest it is likely to work as well. But this is uncertain because it is not clear if the evidence represents people who would have treatment in the NHS.

Because of the uncertainties in the clinical evidence, there are uncertainties in the economic model. It is not possible to determine the most likely cost-effectiveness estimate for glofitamab plus gemcitabine and oxaliplatin. So, it should not be used.