London (Press Release) - People newly diag­nosed with the blood cancer multiple myeloma will now be guaranteed access to bor­tez­o­mib, also known as Velcade.

Multiple myeloma develops from cells in the bone marrow. Almost 4,000 cases are diag­nosed every year in the UK. There is cur­rently no cure; there are only treat­ments to stop its progress and relieve symp­toms.

NICE's independent experts examined the use of bor­tez­o­mib for newly diag­nosed patients who are eli­gible for high-dose chemo­ther­apy and who are suitable for bone marrow trans­plant (haematopoietic stem cell trans­plan­ta­tion). The experts were looking at bor­tez­o­mib in com­bi­na­tion with drugs that help to stop the progress of the myeloma: the steroid dexa­meth­a­sone, or dexa­meth­a­sone and thalido­mide (which cuts the supply of oxygen to the can­cer­ous cells).

Professor Carole Longson, director of the NICE centre for health tech­nology evaluation, said: “We are pleased to recommend bor­tez­o­mib as a first treat­ment for people with multiple myeloma before bone marrow trans­plant. The evi­dence presented to our independent committee showed that having bor­tez­o­mib at this stage will help more patients go on to a bone marrow trans­plant, and consequently prevent the disease from progressing for longer.”

Stem cell trans­plan­ta­tion is the gold standard treat­ment for multiple myeloma because it is asso­ci­ated with im­proved survival. The aim of induction ther­apy is to enable more people to have stem cell trans­plan­ta­tion suc­cess­fully. The current standard induction ther­apy in the UK is the com­bi­na­tion of cyclophosphamide, thalido­mide and dexa­meth­a­sone.

About the guidance

1. The guidance will be available from 23 April 2014.
2. The committee concluded that although there was uncertainty in the magnitude of overall survival gain associated with bortezomib, it was plausible that bortezomib's impact on induction response could be associated with improved overall survival.
3. The cost of bortezomib is £762.38 per 3.5 mg vial. The average cost of a course of treatment with bortezomib given with dexamethasone is estimated to be £12,260.91 and the average cost of a course of treatment with bortezomib given with dexamethasone and thalidomide is estimated to be £24,840.10.
4. The cost per QALY gained for bortezomib, thalidomide and dexamethasone compared with thalidomide and dexamethasone, and for bortezomib and dexamethasone compared with cyclophosphamide, thalidomide and dexamethasone and compared with vincristine, doxorubicin and dexamethasone, were likely to be below £30,000 per QALY gained and so bortezomib was considered an acceptable use of NHS resources.
5. NICE already recommends bortezomib monotherapy as an option for the treatment of progressive multiple myeloma in people who are at first relapse having received one prior therapy and who have undergone, or are unsuitable for, bone marrow transplantation.
6. Thalidomide in combination with an alkylating agent and a corticosteroid is recommended as an option for the first-line treatment of multiple myeloma in people for whom high-dose chemotherapy with stem cell transplantation is considered inappropriate. Bortezomib (Velcade, Janssen) is also recommended under these circumstances, if the person is unable to tolerate or has contraindications to thalidomide.
7. Lenalidomide in combination with dexamethasone is recommended as a treatment option for people with multiple myeloma who have received two or more prior therapies.

About NICE

The National Institute for Health and Care Excellence (NICE) is the independent body responsible for driving im­prove­ment and excellence in the health and social care system. We develop guidance, standards and in­­for­ma­tion on high-quality health and social care. We also advise on ways to promote healthy living and prevent ill health.

Formerly the National Institute for Health and Clinical Excellence, our name changed on 1 April 2013 to reflect our new and addi­tional responsibility to develop guidance and set quality standards for social care, as outlined in the Health and Social Care Act (2012).

Our aim is to help practitioners deliver the best possible care and give people the most effective treat­ments, which are based on the most up-to-date evi­dence and provide value for money, in order to reduce inequalities and variation.

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Source: NICE.