Idelalisib for treating refractory follicular lymphoma

1.1 Idelalisib is not recommended, within its marketing authorisation, for treating follicular lymphoma that has not responded to 2 prior lines of treatment in adults.

1.2 This recommendation is not intended to affect treatment with idelalisib 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 clinician consider it appropriate to stop.

Why the committee made these recommendations

The options after 2 lines of treatment for follicular lymphoma in the NHS include a range of chemotherapy treatments. The choice of the specific treatment depends on what the person has had already.

Idelalisib has not been compared directly with current individual chemotherapeutic treatments. There are several complex indirect comparisons of idelalisib, but these are based on sparse data and have other problems. So, it is unclear whether idelalisib is better than individual chemotherapeutic regimens currently offered by the NHS and, if so, by how much.

There is a wide range of cost-effectiveness estimates but, because the evidence is weak, idelalisib is not considered to represent a cost-effective use of NHS resources. Therefore, idelalisib cannot be recommended for routine use in the NHS.

Idelalisib cannot be recommended for inclusion in the Cancer Drugs Fund. This is because data collected in the Cancer Drugs Fund cannot resolve the key problems determining whether idelalisib is more effective that chemotherapy, nor document the adverse effects associated with individual chemotherapeutic regimens.