Lenalidomide plus dexamethasone for multiple myeloma after 1 treatment with bortezomib

1.1 Lenalidomide plus dexamethasone is recommended as an option for treating multiple myeloma in adults only if:

1.2 This recommendation is not intended to affect treatment with lenalidomide 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 clinician consider it appropriate to stop.

Why the committee made these recommendations

Currently, multiple myeloma is first treated with thalidomide-based therapy but, if a person can't have thalidomide, bortezomib-based therapy can be given. For people who have had bortezomib as a first treatment, the second treatment would be with cytotoxic chemotherapy. However, clinical evidence shows that lenalidomide plus dexamethasone is more effective than cytotoxic chemotherapy.

The most plausible cost-effectiveness estimate for lenalidomide plus dexamethasone may be above the range that NICE normally considers to be a cost-effective use of NHS resources. However, lenalidomide has been recommended for use as a first treatment (for which it is cost effective). Therefore, the need for lenalidomide as a second treatment will likely decrease because people are more likely to have it as a first treatment in the future. However, some people who are currently taking bortezomib as a first treatment will value access to lenalidomide as an effective next treatment option. 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.