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Pembrolizumab for treating relapsed or refractory classical Hodgkin lymphoma after stem cell transplant or at least 2 previous therapies

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1 Recommendations

1.1 Pembrolizumab is recommended as an option for treating relapsed or refractory classical Hodgkin lymphoma in people aged 3 and older. It is only recommended if:

  • they have had an autologous stem cell transplant that has not worked

  • they have not had brentuximab vedotin and

  • the company provides pembrolizumab according to the commercial arrangement (see section 2).

1.2 This recommendation is not intended to affect treatment with pembrolizumab 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. This decision should be made jointly by the clinician and the child or young person and the child's and young person's parents or carers, where applicable.

Why the committee made these recommendations

Pembrolizumab is an additional treatment option for people with relapsed or refractory classical Hodgkin lymphoma. Clinical trial evidence shows that pembrolizumab delays the condition getting worse. It is not known if people having pembrolizumab live longer, because longer-term evidence from the KEYNOTE-204 trial is not available yet.

Pembrolizumab is a cost-effective use of NHS resources for treating relapsed or refractory classical Hodgkin lymphoma in people who have had an autologous stem cell transplant that has not worked but have not had brentuximab vedotin. So, it is recommended for use in the NHS in this population.

The cost-effectiveness estimates are uncertain in people who have had 2 previous anticancer treatments and have not had an autologous stem cell transplant and brentuximab vedotin. The most plausible cost-effectiveness estimate may be within the range usually considered cost effective or may be much higher. Because of this uncertainty, pembrolizumab cannot be recommended for this population.