Bad news on the Rituximab maintenance

I have been keeping tabs on the progress of Rituximab as it goes through the NICE approval process (previous blog posts refer, especially from late summer / autumn last year). Knowing that it was around this time of the year that the committee were supposed to be making a judgement, I had a look at the NICE website just now. It has indeed been considered by the committee and this is their judgement:

The Committee is minded not to recommend rituximab for first-line maintenance treatment of people with advanced follicular non-Hodgkin’s lymphoma that has responded to first-line induction therapy with rituximab in combination with chemotherapy.


The Committee recommends that NICE requests from the manufacturer further clarification, which should be made available for the next Appraisal Committee meeting.
 
Now, there is a door ajar there for the manufacturer to provide more information, but, reading through the rest of the report (available here: http://guidance.nice.org.uk/TA/Wave19/59/Consultation/DraftGuidance), this is not good news.
 
I am fortunate that, because my haematologist has recommended the treatment, BUPA will pay for it. The question that is raised by this report, however, is "How effective is this maintenance?"
 
Well, a conclusion is that it is effective, but that the manufacturer could not demonstrate how effective.
 
The Committee concluded that the available evidence shows that first-line maintenance treatment with rituximab improves progression-free survival compared with observation, but that the size of any overall survival benefit could not be determined.
 
Further, there is no evidence that I have seen on my first skim through, that suggests an overall improvement in life expectancy, rather than just a shifting of the need for second round of chemotherapy. 
 
I need to study the report in more detail later, but overall this doesn't look great.

I need to get out and take some photographs...