Obinutuzumab not recommended for untreated follicular lymphoma in Scotland

Obinutuzumab is a newer antibody that could offer an alternative to rituximab, an antibody treatment widely used to treat non-Hodgkin lymphoma.

Last year, we reported on the results of the GALLIUM trial, which showed that obinutuzmab may be more effective than rituximab for people with untreated advanced-stage (widespread) follicular lymphoma. A small increase in progression-free survival (time people live without follicular lymphoma getting worse) was seen with obinutuzumab. However, it is not clear whether people live longer overall with obinutuzumab compared with rituximab.

On 15 January, the Scottish Medicines Consortium (SMC) published guidance that obinutuzumab in combination with chemotherapy is not recommended as a first treatment for people with advanced-stage follicular lymphoma. The committee considered that there was not enough evidence that the newer antibody gave benefits that justify the additional cost of this treatment.

Although there is a small increase in progression-free survival with obinutuzumab compared with rituximab, there is not enough evidence that obinutuzumab helps people live longer overall.

The obinutuzumab group had more side effects than the rituximab group in the GALLIUM trial.

Obinutuzumab is only available as an intravenous infusion (given by drip into a vein) whereas many people can have rituximab as a subcutaneous injection (injection under the skin), which is much quicker.

Obinutuzumab is currently being assessed by the National Institute for Health and Care Excellence (NICE) for this use in the rest of the UK.

Obinutuzumab is available on the NHS in Scotland and through the Cancer Drugs Fund in England for people who do not respond to rituximab or whose lymphoma gets worse within 6 months of having rituximab. In these cases, it is given with bendamustine chemotherapy.

Jonathan Pearce, the Lymphoma Association’s CEO, commented saying, ‘It’s clear from the research that there is a place for obinutuzumab in the treatment of follicular lymphoma, so it’s disappointing news that the SMC has chosen not to recommend it in this instance. A positive recommendation would have given clinicians the opportunity to learn more about the treatment outside of clinical trials and for the benefit of patients in the real world.’