An illustration of T cells (white) attacking a tumour (purple)
NHS clinicians in England will be among the first to offer a cutting-edge personalised cancer treatment to some people with lymphoma, after the CAR T cell therapy was approved for NHS use.
Tecartus – a immune-boosting treatment that engineers a patient’s own immune cells to kill their cancer – has been recommended by the National Institute for Health and Care Excellence (NICE) for people with a rare type of non-Hodgkin lymphoma.
NICE estimates that around 100 people a year with mantle cell lymphoma could be treated with this therapy. Kruti Shrotri, head of policy development at Cancer Research UK, said the news will be welcomed by people with mantle cell lymphoma.
A personalised treatment
Tecartus works by taking a person’s own immune cells and altering them in a lab to recognise and attack cancer cells, before infusing them back into the bloodstream.
It’s one of a number of CAR T cell therapies that have been developed, the first of which was approved for NHS use in England in 2018.
“We are pleased to be able to recommend another revolutionary CAR T cell therapy, this time for adults with mantle cell lymphoma, which represents a step forward for personalised medicine.” – Meindert Boysen, deputy chief executive and director of NICE’s centre for health technology evaluation.
Today’s decision will mean that more patients can benefit from this personalised immunotherapy approach. Tecartus will now be an option when someone’s cancer has stopped responding to their current therapy or who have experienced a relapse after being treated with an existing group of targeted therapies (BTK inhibitors) such as ibrutinib.
Rates of relapse after initial treatment are high and there’s currently no standard treatment for adults with this type of cancer, who are usually in their 70s, once their cancer comes back or stops responding to targeted treatments like ibrutinib. Combination chemotherapy is the most commonly follow up treatment.
The NICE committee agreed that there was an unmet need for more effective treatment options. And while CAR T cell therapy is an intense treatment – often requiring several weeks in hospital – they agreed that both patients and healthcare professionals would welcome new treatment options that improve the chance of survival and offer the potential for a cure.
Determining long-term benefit
Evidence from a study of Tecartus seen by the NICE committee suggests that people being treated with CAR T cell therapy may live longer and have more time before their disease comes back.
But there’s not yet enough evidence to tell if lymphoma patients can be cured using CAR T cell therapy. NICE has therefore agreed for the treatment to be made available via the Cancer Drugs Fund so that patients can access the treatment while more data is collected on its long-term benefits.
“CAR T-cell therapy is expensive,” said Boysen. “The treatment is specific to each individual and could be a potential cure for some, although it is early days. Our recommendation for Tecartus, on the Cancer Drugs Fund, means people can benefit while more data is collected.”
In particular, NICE has asked for further data to be collected on progression-free survival, overall survival and the age when treatment starts. This will help improve understanding of treatment benefits while the treatment is being used on NHS patients.
Shrotri commented that because mantle cell lymphoma is quite rare, and because this type of treatment is complex and expensive, it can be difficult to generate enough evidence to show that a treatment is cost-effective.
“It is great to see NICE, NHS England and the manufacturer working together to bring this treatment to patients,” she added.
There are currently 10 approved NHS providers able to offer this one-time treatment in England, meaning patients may be required to travel to receive it.
NICE decisions are usually adopted in Wales and Northern Ireland, so some people with mantle cell lymphoma may also benefit from this treatment. Scotland has a separate process for reviewing drugs.
NICE (2020) Autologous anti-CD19-transduced CD3+ cells for treating relapsed or refractory mantle cell lymphoma [ID1313]