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An immunomodulator drug to fight multiple myeloma should be available for more patients on the NHS in England and Wales, the National Institute for Health and Care Excellence (NICE) announced today.

Lenalidomide (Revlimid, Celgene) could soon be offered to patients with this form of plasma cell cancer as a first- and second-line drug, it said.

Multiple Myeloma

In final draft guidance, NICE recommended lenalidomide in combination with dexamethasone as an option for previously untreated multiple myeloma in adults who are not eligible for a stem cell transplant and cannot take thalidomide.

The committee explained that people with multiple myeloma are first treated with thalidomide-based therapy but, if a patient cannot have thalidomide, bortezomib-based therapy is an option.

For people who have had bortezomib (Velcade, Janssen-Cilag) 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.

NICE decided that as it already recommended lenalidomide as both a first and third treatment for multiple myeloma, it was appropriate to recommend lenalidomide for this small patient group as a second treatment.

In further final draft guidance, NICE also recommended lenalidomide as an option for treating multiple myeloma in adults if they have had only one previous therapy, which included bortezomib.

It said patients were currently offered chemotherapy as a second treatment after bortezomib. However, clinical evidence showed that lenalidomide with dexamethasone substantially improved the length of time people lived compared to bortezomib-based therapy. In one clinical study, patients taking lenalidomide lived on average seven months longer, it said.

Since NICE already recommended lenalidomide as a third-line treatment, it considered it appropriate to also recommend it as second-line option.

NICE estimated that the changes would benefit an estimated 320 people.

Meindert Boysen, director of the Centre for Health Technology Evaluation at NICE, said: "We are pleased to recommend lenalidomide for these patients.

"Not only will this drug improve the length of time people live, but it will also have fewer side effects compared with current treatments.

"Multiple myeloma is normally treated with a thalidomide-based therapy at first line; however, there is considerable need for new therapies for those who cannot take thalidomide. The new decision by NICE now means that those patients have an effective alternative."

The manufacturer has agreed to provide lenalidomide at a commercially confidential discount.

Shelagh McKinlay, head of patient advocacy at the charity Myeloma UK, commented: "This double approval from NICE is a significant step forward in building the best possible treatment pathway for patients in England and Wales.

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