Talquetamab can be used as an option to treat relapsed and refractory multiple myeloma in adults when:
they have had 3 or more lines of treatment including:
an immunomodulatory drug
a proteasome inhibitor, and
an anti-CD38 antibody, and
the myeloma has progressed on the last treatment.
Talquetamab can only be used if the company provides it according to the commercial arrangement.
This recommendation is not intended to affect treatment with talquetamab that was started in the NHS before this guidance was published. People having treatment outside this recommendation may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS healthcare professional consider it appropriate to stop.
What this means in practice
Talquetamab must be funded in the NHS in England for the condition and population in the recommendations, if it is considered the most suitable treatment option. Talquetamab must be funded in England within 90 days of final publication of this guidance.
There is enough evidence to show that talquetamab provides benefits and value for money, so it can be used routinely across the NHS in this population.
NICE has produced tools and resources to support the implementation of this guidance.
For this evaluation, the company compared talquetamab with teclistamab. Teclistamab is one of the standard treatments for multiple myeloma that has relapsed (come back) and is refractory (has stopped responding to treatment) after 3 or more lines of treatment and that has progressed on the last treatment. Using teclistamab or talquetamab only after 3 lines of treatment is narrower than the marketing authorisations, which specify use after 3 treatments.
The evidence from clinical trials is uncertain because:
the teclistamab trial was done during the COVID‑19 pandemic, which could have affected the number of deaths
some people in the trials had treatments after teclistamab or talquetamab that are not available in the NHS.
But the results from an indirect comparison suggest that talquetamab increases how long people live compared with teclistamab, and real-world evidence supports this.
The most likely cost-effectiveness estimates are within the range that NICE considers an acceptable use of NHS resources. So, talquetamab can be used.