Myeloma maintenance treatment not recommended on NHS in England

Cancer Research UK

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Histopathology of myeloma

Histopathology of myeloma. Credit: Wikimedia commons/CC-BY-4.0

This week, lenalidomide (Revlimid) received an initial rejection from the National Institute of Health and Care Excellence (NICE) for use as a maintenance treatment for some adults with myeloma.  

The aim of maintenance therapies is to get rid of any remaining cancer cells after initial treatment. In this case lenalidomide would be used after an autologous stem cell transplant, which uses someone’s own healthy blood stem cells to replace damaged bone marrow. The treatment was being considered for people with newly diagnosed myeloma who had received a stem cell transplant.  

Emlyn Samuel, head of policy development at Cancer Research UK said the decision will be “disappointing” for people affected by myeloma and urged NHS England, NICE and the manufacturer to continue working together to resolve any uncertainties. 

A maintenance treatment for myeloma   

Around 5,800 people are diagnosed with myeloma in the UK every year, but there is currently no maintenance treatment for myeloma patients who have had a stem cell transplant – the disease is usually just monitored until the cancer returns. 

Lemalidomide is already used to treat myeloma after someone’s cancer has returned, in combination with the steroid dexamethasone. However, patients and clinicians told NICE that taking lenalidomide earlier would be better for patients as it would allow them to receive the treatment when they were fitter and potentially preserve more of their quality of life. 

Results from a late-stage clinical trial show that lenalidomide extends the time it takes for someone’s cancer to get significantly worse again compared with just monitoring disease, and increases how long people live overall. 

“Clinical trials have shown that using lenalidomide in this way can help some patients sustain the benefits of initial treatment for longer, giving them more time before their disease gets worse again. Patients also told NICE using lenalidomide at this earlier stage could help preserve greater quality of life.” – Emlyn Samuel, head of policy at Cancer Research UK. 

Uncertainty in the clinical trials 

Despite these promising results, NICE raised concerns over the trial data. In particular, the treatments that patients received after lenalidomide in the trial aren’t used in the NHS in England, which made it harder to work out how much extra benefit lenalidomide might offer NHS patients.  

NICE also argued the manufacturer overstated how long the beneficial effects of lenalidomide would continue after patients stopped taking the drug.  

These factors meant NICE couldn’t be confident that using lenalidomide as a maintenance treatment for myeloma was a cost-effective use of NHS resources. 

This initial decision will be reviewed later this year and Samuel urges NHS England, NICE and the drug manufacturer to continue working together “to resolve these uncertainties and ensure all patients can be offered the best possible treatment”. 

NICE decisions are usually adopted in Wales and Northern Ireland as well as England, so the decision is likely to affect patients in all 3 nations. Scotland has a separate process for reviewing drug decisions. 

References

NICE (2020) Lenalidomide maintenance treatment after an autologous stem cell transplant for newly diagnosed multiple myeloma. [ID475]