Lenalidomide with rituximab for previously treated follicular lymphoma

1.1 Lenalidomide with rituximab is recommended, within its marketing authorisation, as an option for previously treated follicular lymphoma (grade 1 to 3A) in adults. It is only recommended if the company provides lenalidomide according to the commercial arrangement.

Why the committee made these recommendations

Follicular lymphoma is usually treated with an anti‑CD20 antibody (such as rituximab) with chemotherapy. Treatment options are limited, especially if the disease relapses early after a rituximab-based treatment. Lenalidomide is the first approved targeted treatment for follicular lymphoma that is not an anti‑CD20 antibody. Lenalidomide is taken orally, and when used with rituximab is a chemotherapy-free combination.

Clinical-effectiveness evidence shows that, when people take lenalidomide with rituximab, their follicular lymphoma does not progress as quickly as when they take rituximab with chemotherapy. There is also evidence that lenalidomide with rituximab helps people live longer than rituximab with chemotherapy, although it is too early to tell for how much longer.

Lenalidomide with rituximab costs more than rituximab with chemotherapy. However, its cost-effectiveness estimate is within the range that NICE normally considers an acceptable use of NHS resources. Therefore, lenalidomide with rituximab is recommended.