Teclistamab is recommended as an option for treating relapsed and refractory multiple myeloma in adults, only after 3 or more lines of treatment (including an immunomodulatory drug, a proteasome inhibitor and an anti-CD38 antibody) when the myeloma has progressed on the last treatment. It is only recommended if the company provides teclistamab according to the commercial arrangement.
This recommendation is not intended to affect treatment with teclistamab that was started in the NHS before this guidance was published. People having treatment outside this recommendation may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS healthcare professional consider it appropriate to stop.
Why the committee made these recommendations
The main treatment that is used for relapsed (has come back) and refractory (has stopped responding to treatment) multiple myeloma after 3 or more lines of treatment is pomalidomide plus dexamethasone. If pomalidomide plus dexamethasone is not suitable, panobinostat plus bortezomib and dexamethasone can be used. If the myeloma is refractory to 5 or more treatments, selinexor plus dexamethasone can be used. For this evaluation, the company only compared teclistamab with treatments that are used after 3 or more lines of therapy. This does not include everyone who it is licensed for.
Teclistamab has not been directly compared in a clinical trial with pomalidomide plus dexamethasone, panobinostat plus bortezomib and dexamethasone, or selinexor plus dexamethasone. An indirect comparison suggests that teclistamab increases how long people have before their cancer gets worse and how long they live compared with these treatments.
When considering the condition's severity, and its effect on quality and length of life, the most likely estimates are within the range that NICE considers an acceptable use of NHS resources. So, teclistamab is recommended after 3 or more lines of treatment (including an immunomodulatory drug, a proteasome inhibitor and an anti-CD38 antibody) when the myeloma has progressed on the last treatment.