In its final guidance the UK's National Institute of Clinical Excellence (NICE) has recommended that thalidomide and bortezomib can be used as first line treatments for some patients with multiple myeloma.

The guidance approved thalidomide (Celgene) as first line treatment of multiple myeloma in people for whom high-dose chemotherapy with stem cell transplantation was considered inappropriate.

NICE also backed bortezomib (Velcade, Janssen) for first-line treatment of multiple myeloma if high-dose chemotherapy with stem-cell transplantation is considered inappropriate and also if the patient is unable to tolerate or has contraindications to thalidomide. Both drugs must be given in combination with an alkylating agent and a corticosteroid.

Bortezomib is an anticancer drug that works by reversible proteasome inhibition; while thalidomide is an immunomodulatory agent thought to have multiple actions including anti-inflammatory activity and the ability to inhibit the growth and survival of myeloma cells and new blood vessels.

Recommendations were originally made in draft guidance last August, but Janssen launched an appeal, stating that bortezomib should be considered a clinically and cost effective treatment option for newly diagnosed patients. NICE ruled that the thalidomide and bortezomib regimens were considered similar in terms of clinical effectiveness, but that thalidomide was more cost effective.

The average cost of bortezomib which is given intravenously per treatment cycle is £3,000, versus £2,100 for Thalidomide which is taken orally.

Multiple myeloma is the second most common haematological cancer in the UK. It remains an incurable disease with an average survival of four to six years. The aim of treatment is to extend the length and quality of life by alleviating symptoms, controlling disease and minimising adverse effects.

The majority of patients with multiple myeloma are not able to withstand intensive treatments, such as high-dose chemotherapy with stem cell transplantation, due to their age and co-morbidities. These people have been offered single-agent of combination chemotherapy.

Carole Longson, Health Technology Evaluation Centre Director at NICE, said, "Thalidomide and bortezomib regimens have been shown to be more effective at delaying disease progression and improving patients' life expectancy than the current treatment of an alkylating agent and corticosteroid alone."

Reference

Bortezomib and thalidomide for the first-line treatment of multiple myeloma.  NICE July 2011 DOI: doi:10.1016/S1470-2045(11)70202-9