An editorial discusses whether obinutuzumab should replace rituximab as the standard antibody in the treatment of patients on chemoimmunotherapy regimens for follicular lymphoma. It notes that this trial suggests there might be no advantage for an obinutuzumab-based chemoimmunotherapy regimen if maintenance treatment was not planned, but even with maintenance therapy, there is no evidence from this trial of an overall survival benefit with obinutuzumab. Furthermore, these findings, combined with higher rate of toxic effects and, higher cost of obinutuzumab, raise important questions regarding the advantage of its use. It adds that this issue is further complicated because it is possible that giving rituximab at a dose of 1000 mg might reduce or eliminate any difference in progression-free survival. It suggests that when the data on minimal residual disease become available, the case for obinutuzumab may appear to be more compelling if a higher proportion of patients who received obinutuzumab have minimal residual disease status at some point in treatment and remain in remission longer than those who received rituximab. At the moment, it concludes that the competition between these agents looks too close to call.
DRAFT NICE guidance does not recommend the use of obinutuzumab as induction treatment with chemotherapy, then alone as maintenance therapy, for untreated advanced follicular lymphoma in adults as it was not considered a cost-effective use of NHS resources. The Committee noted that there are not enough data to know whether obinutuzumab increases life expectancy, and it costs more than branded rituximab and the biosimilar versions of rituximab.