The obinutuzumab debate

Newer antibody still not recommended in Scotland

NICE assessment

In January, we reported on the Scottish Medicines Consortium’s (SMC) decision not to recommend obinutuzumab (Gazyvaro®) as a first-line treatment for people with follicular lymphoma.

The SMC have looked at the evidence again and on 10 September published guidance confirming their previous position that they were unable to recommend this treatment for use on the NHS in Scotland.

In the meantime, obinutuzumab has been recommended by the National Institute for Health and Care Excellence (NICE) as an option for certain people with untreated follicular lymphoma on the NHS in the rest of the UK. However, it is only recommended for people with risk factors suggesting their lymphoma is more likely to get worse soon after treatment. 

Obinutuzumab is an antibody treatment that is used together with chemotherapy for people with previously untreated advanced-stage (widespread) follicular lymphoma. The current standard first-line treatment for these people is another antibody treatment, rituximab, with chemotherapy. Clinical trials have shown that there is a small increase in progression-free survival (time without the lymphoma getting worse) with obinutuzumab compared with rituximab, but this may come with more side effects. Obinutuzumab also has to be given intravenously (into a vein) but rituximab can be given subcutaneously (by injection under the skin) for some people which is much quicker.

What does this mean for me?

If you have untreated advanced-stage follicular lymphoma, discuss your treatment options with your doctor. It is important to remember that rituximab with chemotherapy is a very effective treatment for follicular lymphoma. In Scotland, obinutuzumab is available on the NHS for people who do not respond to rituximab.

Dr Pam McKay, Consultant Haematologist, Beatson West of Scotland Cancer Centre says: 'Most people with follicular lymphoma live for many years and require a number of treatments over that time. The aim of treatment is to keep the disease under control with the minimal of toxicities (side effects). There are many options for treatment at the various stages of the disease. Whilst obinutuzumab is a very effective drug, it may have more side effects than rituximab and it is less convenient for patients (more attendances at day ward and for longer). Obinutuzumab is available for patients who do not respond to rituximab and is effective in this setting.'

Lymphoma Action would like to thank Dr McKay for providing input into this article. Dr McKay is a member of our Medical Advisory Panel, a group of expert clinicians and scientists who work with our charity to help us to inform and support people with lymphoma.