NICE recommends Velcade for new myeloma patients

New draft guidance from NICE recommended Velcade (bortezomib) as a first line treatment for some patients with multiple myeloma.

The new recommendation is a welcome change of heart from NICE, which in its first appraisal in November had rejected the drug for use in newly diagnosed patients.

The guidance means Velcade can be used in combination with dexamethasone, or with dexamethasone and thalidomide for the induction treatment of adult patients with previously untreated multiple myeloma, who are eligible for high-dose chemotherapy with haematopoietic stem cell transplantation (bone marrow transplant).

Multiple myeloma is a cancer that develops from cells in the bone marrow, and around 4,000 cases are diagnosed every year in the UK. There is currently no cure for the disease, only treatments to stop the progress of the condition and help relieve symptoms.

Sir Andrew Dillon, NICE Chief Executive, said: “We are very pleased to propose adding bortezomib to the number of treatments for different stages of the disease. Clinical specialists told the committee that induction treatment with bortezomib would enable a greater number of patients to proceed to a bone transplant and consequently prevent the disease from progressing for longer.”

NICE’s committee changed its initial decision after Janssen responded to a request for further evidence on the clinical and cost effectiveness of Velcade in combination with dexamethasone compared with current standard treatment of newly diagnosed patients who are suitable for high dose chemotherapy with haematopoietic stem cell transplantation. Standard treatment in the UK is a combination of cyclophosphamide, thalidomide and dexamethasone.

The committee concluded that although there was uncertainty in the magnitude of overall survival gain associated with Velcade, it was plausible that the drug’s impact on induction response could be associated with improved overall survival.

NICE already recommends Velcade monotherapy as an option for the treatment of progressive multiple myeloma in people who are at first relapse having received one prior therapy and who have undergone, or are unsuitable for, bone marrow transplantation.

Thalidomide (marketed by Celgene) in combination with an alkylating agent and a corticosteroid is recommended as an option for the first-line treatment of multiple myeloma in people for whom high-dose chemotherapy with stem cell transplantation is considered inappropriate.

Velcade is also recommended under these circumstances, if the person is unable to tolerate or has contraindications to thalidomide.

Celgene’s Revlimid (lenalidomide) in combination with dexamethasone is recommended as a treatment option for people with multiple myeloma who have received two or more prior therapies.

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