Selinexor plus dexamethasone is recommended, within its marketing authorisation, for treating multiple myeloma in adults when:
they have had 4 or more treatments, and
the condition is refractory to at least 2 proteasome inhibitors, 2 immunomodulatory agents and an anti‑CD38 monoclonal antibody (penta-refractory), and
the condition has progressed on the last treatment, and
the company provides it according to the commercial arrangement.
Why the committee made these recommendations
Standard care for relapsed or refractory multiple myeloma after 4 or more treatments is best supportive care (BSC).
There is no direct clinical trial evidence that compares selinexor plus dexamethasone with BSC. But evidence from indirect comparisons suggests that it increases how long people live compared with BSC.
There is uncertainty in the economic model for selinexor plus dexamethasone. But, when considering the condition's severity, and effect on quality and length of life, the most likely cost-effectiveness estimates are below what NICE considers to be a cost-effective use of NHS resources. So, selinexor plus dexamethasone is recommended.