Mosunetuzumab for treating relapsed or refractory follicular lymphoma

1.1 Mosunetuzumab is not recommended, within its marketing authorisation, for treating relapsed or refractory follicular lymphoma in adults who have had 2 or more systemic therapies.

1.2 This recommendation is not intended to affect treatment with mosunetuzumab 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

Treatment options for relapsed or refractory follicular lymphoma are limited and there is no standard care. After 2 previous therapies, treatment may include rituximab plus lenalidomide or rituximab plus chemotherapy.

Clinical evidence suggests that follicular lymphoma responds to treatment with mosunetuzumab, so the cancer may not get worse as quickly. But these results are from a trial that did not compare mosunetuzumab with placebo or any other treatment options. Indirect comparisons of mosunetuzumab with other treatment options are very uncertain with inconsistent results.

The cost-effectiveness estimates for mosunetuzumab are highly uncertain and do not represent a cost-effective use of NHS resources. So, mosunetuzumab is not recommended for routine use in the NHS.

Mosunetuzumab cannot be recommended with managed access. This is because mosunetuzumab is not likely to be cost effective. Also, more data collected in the Cancer Drugs Fund would not resolve the high level of uncertainty.