NICE decision on first-line lenalidomide for multiple myeloma


  • Dawn O'Shea
  • Oncology drug update
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Lenalidomide will now be available on the NHS for the first- and second-line treatment of multiple myeloma.

In final draft guidance, NICE has recommended lenalidomide in combination with dexamethasone as an option for previously untreated multiple myeloma in adults who are not eligible for stem cell transplant and cannot take thalidomide. The decision is expected to benefit approximately 2100 patients.

The evidence to support the decision is taken from an indirect comparison which suggests lenalidomide plus dexamethasone improves overall survival compared with bortezomib-melphalan-prednisone (VMP) (hazard ratio [HR] 0.70; 95% credible interval [CrI] 0.50-0.98). For progression-free survival, the hazard ratio for lenalidomide plus dexamethasone compared with VMP was 0.74 (95% CrI 0.52-1.05).

Additionally, in a second piece of final draft guidance, NICE has also recommended lenalidomide as an option for treating multiple myeloma in adults if they have had only one previous therapy, which includes bortezomib.

“Given that NICE already recommends lenalidomide as both a first and third treatment for multiple myeloma, it is appropriate to recommend lenalidomide for this small patient group as a second treatment,” the draft guidance states.

“Since lenalidomide is now recommended for use as a first treatment, it is expected that the need for a second-line treatment will reduce. That means approximately 320 patients are expected to benefit,” NICE says.

Myeloma is now the 19th most common cancer in the UK, accounting for 2% of all new cancer cases. Over the last decade, UK incidence rates have increased by 17%.

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