NICE (UK) positive for Blenrep with pomalidomide and dexamethasone for previously treated multiple myeloma – GSK
NICE(UK): Belantamab mafodotin plus pomalidomide and dexamethasone can be used as an option to treat multiple myeloma in adults, if: i) they have only had 1 line of treatment and that contained lenalidomide, and ii) lenalidomide is not tolerated or the condition is refractory to it. Belantamab mafodotin can only be used if the company provides it according to the commercial arrangement.
Why the committee made these recommendations: Belantamab mafodotin plus pomalidomide and dexamethasone is licensed for use at second line and beyond. But, for this evaluation, the company asked for it to be considered only as a treatment at second line. It provided evidence for multiple myeloma when lenalidomide is not tolerated or the condition is refractory to it. Usual treatment for multiple myeloma after 1 line of treatment that includes lenalidomide is: i) carfilzomib plus dexamethasone ii) daratumumab plus bortezomib and dexamethasone iii) selinexor plus bortezomib and dexamethasone, if the multiple myeloma is refractory to both daratumumab and lenalidomide.
Clinical trial evidence shows that belantamab mafodotin plus pomalidomide and dexamethasone increases how long people have before their condition gets worse compared with pomalidomide plus bortezomib and dexamethasone. But pomalidomide plus bortezomib and dexamethasone is not used in the NHS. There have been no other direct comparisons. Indirect comparisons suggest that belantamab mafodotin plus pomalidomide and dexamethasone increases how long people have before their condition gets worse compared with: i) carfilzomib plus dexamethasone ii) daratumumab plus bortezomib and dexamethasone iii) selinexor plus bortezomib and dexamethasone. They do not show that it increases how long people live compared with these usual treatments. Also, these indirect comparison results are highly uncertain.
There are also uncertainties in the economic model. But the cost-effectiveness estimates for belantamab mafodotin plus pomalidomide and dexamethasone are within the range that NICE considers an acceptable use of NHS resources. So, it can be used.
