NHS England to fund engineered cell therapy for adults with aggressive lymphoma

A cancer immunotherapy will be offered on the NHS in England to some adults with aggressive non-Hodgkin lymphoma, NHS England announced today. 

Axicabtagene ciloleucel (Yescarta) is one of a new line of immune-boosting treatments called CAR T cell therapies, which involve taking a patient’s own immune cells and modifying them in the lab. When the engineered cells are given back to the patient, they are primed to recognise and attack the cancer cells. 

The treatment will be offered to patients with two aggressive types of non-Hodgkin lymphoma who have already had two or more different types of treatment. It was initially turned down in August, but that decision has since been reviewed.

According to NHS England, up to 200 patients a year could benefit from the treatment. 

In a clinical trial of 101 people who took Yescarta, 8 in 10 people saw their disease respond to Yescarta and half of these people were cancer free six months after treatment. But the drug also led to serious side effects in over half of patients.

Rose Gray, Cancer Research UK’s policy manager, said NHS England’s announcement was “fantastic news” and means patients in England will be the first in Europe to get the treatment. 

Discount deal reached

Yescarta was initially turned down by the National Institute for Health and Care Excellent (NICE) in August, after the committee decided the treatment was too expensive and its benefits compared to standard chemotherapy weren’t known.

The treatment usually costs nearly £300,000 per patient, but NHS England has reached a confidential discount deal with Yescarta’s manufacturer, Gilead Sciences. It will be made available via the Cancer Drugs Fund, which was redesigned in 2016 to speed up access to promising new cancer treatments. 

Changes to the fund mean that data on the treatment’s effectiveness can be collected in those patients who are treated.

“It’s great that NHS England, NICE and the company have worked together to make this complex and highly personalised treatment available so quickly, through the Cancer Drugs Fund,” said Gray. “This will mean patients can get this treatment quickly, while more information is gathered on its long-term effectiveness.”

As Yescarta is a complex treatment to administer and uses a patient’s own immune cells, hospitals need a have a special accreditation to offer it. NHS England announced that it is preparing for the treatment to be available at specialist hospitals in Birmingham, Bristol, London, Manchester and Newcastle.

More on this story: ‘Cutting edge’ CAR T cell immunotherapy approved in England. But is the NHS ready?

A growing number of personalised cell therapies

In September, NHS England announced that it would fund another CAR T cell therapy (Kymriah) for some children and young adults with leukaemia.

Simon Stevens, chief executive of NHS England, said that “thanks to investment in game-changing techniques like CAR T, the NHS is at the forefront of providing a new wave of personalised treatments that are individually tailored to patients.”

Kymriah has also been tested in adults with an aggressive type of non-Hodgkin lymphoma for whom standard treatment has failed. The treatment was initially rejected for use on the NHS in England to treat this group of patients, after NICE decided the treatment was too expensive and there wasn’t enough long-term data to demonstrate Kymriah’s effectiveness.

This decision will be reviewed at the end of October.