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The same trials are read in both countries and reach different conclusions, because the British system asks what a treatment costs for the benefit it gives and the American one asks whether it is better at all. This is a list of the places where a patient's treatment would genuinely differ.
Advanced Hodgkin lymphoma. In the United States, SWOG S1826 made nivolumab with AVD the standard for stage III and IV disease in adults and adolescents 12 and over (two-year progression-free survival 92 against 83 per cent for brentuximab-AVD). In Germany and much of Europe, GHSG HD21 made PET-guided BrECADD the standard for fit patients aged 18 to 60 (four-year progression-free survival 94.3 against 90.9 per cent for escalated BEACOPP, with less treatment-related morbidity). British practice has historically used ABVD with PET adaptation after RATHL; NICE TA1059 now recommends brentuximab vedotin with doxorubicin, dacarbazine and vinblastine for untreated stage 3 or 4 CD30-positive disease, so A-AVD is funded first line in England, while no NICE appraisal of nivolumab with AVD exists. A patient with the same disease would receive a checkpoint inhibitor in Boston, an intensive alkylator regimen in Cologne and PET-adapted ABVD or A-AVD in many British units.
Mantle cell lymphoma in older patients. ENRICH, a British-led trial in 397 patients aged 60 and over, showed ibrutinib with rituximab beats immunochemotherapy (adjusted hazard ratio 0.69), with the benefit concentrated against R-CHOP (0.37) rather than against bendamustine-rituximab (0.91). SHINE, the international trial, added ibrutinib to bendamustine-rituximab and lengthened progression-free survival from 52.9 to 80.6 months without lengthening life. American practice leans on covalent BTK inhibitors with chemotherapy or, increasingly, chemotherapy-free; British practice follows ENRICH.
First-line diffuse large B-cell lymphoma. Pola-R-CHP is standard in the United States for IPI 2 and above. In England it is commissioned for a defined group, and R-CHOP remains the most common first treatment.
Relapsed disease. Bispecific antibodies and CAR-T are available in both countries but the routes differ: in England they are commissioned nationally, delivered at a few centres and reached by panel approval; in the United States they are reached through insurance authorisation at an accredited centre. Which is faster depends on the individual case, not on the system.
Supportive care. Growth factor use is more liberal in the United States. CNS prophylaxis with high-dose methotrexate has been abandoned faster in the United Kingdom than in the United States.
Backbone ribbon from PDB 5WT9. RCSB PDB 5WT9. The ribbon widens where the chain is folded into a regular pattern and narrows where it is a loose loop.
Showing the molecule this term concerns: Nivolumab.
Shares RATHL, Early-stage classical Hodgkin lymphoma (stage I to II), Relapsed and refractory classical Hodgkin lymphoma, Advanced-stage classical Hodgkin lymphoma (stage III to IV).
Shares GHSG HD21, Early-stage classical Hodgkin lymphoma (stage I to II), Relapsed and refractory classical Hodgkin lymphoma, Advanced-stage classical Hodgkin lymphoma (stage III to IV).
Shares GHSG HD21, SWOG S1826, Early-stage classical Hodgkin lymphoma (stage I to II), Brentuximab vedotin.
Shares RATHL, GHSG HD21, Early-stage classical Hodgkin lymphoma (stage I to II), Relapsed and refractory classical Hodgkin lymphoma.
Shares Polatuzumab vedotin, Early-stage classical Hodgkin lymphoma (stage I to II), Relapsed and refractory classical Hodgkin lymphoma, Brentuximab vedotin.
Shares RATHL, GHSG HD21, Early-stage classical Hodgkin lymphoma (stage I to II), Advanced-stage classical Hodgkin lymphoma (stage III to IV).
Shares SWOG S1826, Brentuximab vedotin, Hodgkin lymphoma, Nivolumab.
Shares RATHL, Brentuximab vedotin, Advanced-stage classical Hodgkin lymphoma (stage III to IV), Hodgkin lymphoma.