Bronchial Thermoplasty Go-ahead for Severe Asthma

Peter Russell

August 31, 2018

An innovative treatment that uses a small catheter to deliver controlled energy to the airways to help control symptoms of severe asthma features in this week's roundup of the latest guidance from the National Institute for Health and Care Excellence (NICE).

Guidance was also issued for a non-Hodgkin lymphoma treatment and a treatment for neuroendocrine cancer tumours.

Bronchial Thermoplasty for Asthma

A novel treatment for severe asthma, bronchial thermoplasty, was given the green light for routine NHS use for patients whose asthma cannot be controlled by drugs.

During bronchial thermoplasty, short pulses of radiofrequency heat are applied to the airway wall while the patient is under sedation or general anaesthetic.

The aim is to reduce the amount of muscle tissue, so there is less to contract and narrow the airway.

Having the procedure may decrease the severity and frequency of severe asthma attacks, thereby improving quality of life.

Professor Kevin Harris, programme director and clinical advisor for the Interventional Procedures Programme at NICE, said: "This is a procedure which is innovative and it does work.

“If you are frequently admitted to hospital with severe asthma which cannot be controlled with drugs, this is a procedure which people may wish to consider after discussions with their clinician."

NICE said its draft recommendation was now subject to consultation prior to issuing final guidance on the treatment.

Non-Hodgkin Lymphoma Drug

Despite describing it as a "step-change" drug, NICE rejected axicabtagene ciloleucel (Yescarta, Kite Pharma) for aggressive subtypes of non-Hodgkin lymphoma.

Axicabtagene ciloleucel is the first of a new line of chimeric antigen receptor T-Cell (CAR-T) therapies, which are specifically manufactured for each individual patient.

Treatment involves taking some of a patient's white blood cells, re-engineering them to recognise and attack cancer cells, and then infusing them back into the patient.

The appraisal committee recognised that results from a small study showed promise but said there was insufficient data to compare it with best supportive care, including the use of salvage chemotherapy.

NICE decided the drug was too costly to recommend for both routine NHS use and the Cancer Drugs Fund in England. However, it asked for further comments and new evidence so it could reconsider its draft guidance in late September 2018.

Neuroendocrine Cancer Treatment

Targeted cancer drug Lutetium (177Lu) oxodotreotide (Lutathera, Advanced Accelerator Applications) was recommended as an option for treating inoperable or metastatic, progressive, well differentiated (G1 and G2) somatostatin receptor-positive gastroenteropancreatic neuroendocrine tumours (NETs) in adults.

Lutetium is a targeted radionuclide therapy or peptide receptor radionuclide therapy that consists of octreotate, a synthetic form of the naturally occurring hormone somatostatin, and lutetium-177, a substance that emits radiation.

After infusion into a patient's vein, the combination treatment attaches itself to the surface of many neuroendocrine tumours, emitting radiation into the tumour, inhibiting its growth and reducing symptoms.

Treatment with lutetium for pancreatic NETs met end-of-life criteria, while treatment for gastrointestinal NETs was "a cost-effective use of NHS resources", NICE said in final guidance.

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