NICE Does Not Recommend Combination Treatment for Multiple Myeloma

Dawn O'Shea

August 27, 2021

In new draft guidance published this week, NICE does not recommend daratumumab plus bortezomib, thalidomide and dexamethasone, for the management of untreated multiple myeloma in adults who are eligible for an autologous haematopoietic stem cell transplant (HSCT).

In part 1 of the two-part randomised, open-label, active-controlled, parallel-group, phase 3 trial CASSIOPEIA study, treatment before and after HSCT with daratumumab plus bortezomib, thalidomide and dexamethasone (D-VTd) significantly improved rates of complete response (CR) and progression-free survival (PFS) versus bortezomib, thalidomide, and dexamethasone (VTd) in patients with newly diagnosed multiple myeloma.

Treatment consisted of four 28-day cycles of induction therapy before autologous HSCT and two 28-day cycles of consolidation therapy after.

In a prespecified secondary analysis, patient-reported outcomes were assessed using the European Organization for Research and Treatment of Cancer quality of life questionnaire-core 30-item (EORTC QLQ-C30) and EuroQol 5-dimensional descriptive system (EQ-5D-5L) questionnaire at baseline, after induction (cycle 4, day 28), and after consolidation (day 100 after autologous HSCT).

Mean changes in global health status scores from baseline to post-induction were not different between the D-VTd group and VTd group or from baseline to post-consolidation between the two groups. However, improvements from baseline in EORTC QLQ-C30 global health status and EQ-5D-5L visual analogue scale scores were observed in post-consolidation scores in both groups, with significantly reduced post-consolidation pain in the D-VTd group, smaller reductions in cognitive functioning, and improved emotional functioning.

The appraisal committed considered that D-VTd is more clinically effective than standard care for untreated multiple myeloma when a stem cell transplant is suitable. However, it highlighted several uncertainties and biases in the company’s economic modelling. The most plausible incremental cost-effectiveness ratios (ICERs) for D-VTd compared with VTd was above the range normally considered to be a cost-effective use of NHS resources. As a result, the appraisal committee concluded that D-VTd could not be recommended for routine use.

The decision is now open for consultation. Comments can be submitted here until September 17, 2021.

This article originally appeared on Univadis, part of the Medscape Professional Network.

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