NICE recommends bortezomib and thalidomide as possible first treatments for some people with multiple myeloma (see below).
Who can have bortezomib and thalidomide?
You should be able to have thalidomide if:
- it’s given with a type of drug called an alkylating agent (for example, melphalan) and a type of drug called a corticosteroid (for example, prednisolone) and
- intensive drug treatment together with a stem cell transplant is not suitable for you.
You should be able to have bortezomib if:
- you would normally be offered thalidomide but you cannot take it because of side effects or other reasons.
Why has NICE said this?
NICE looks at how well treatments work, and also at how well they work in relation to how much they cost the NHS.
NICE recommended thalidomide because it works better than other treatments available on the NHS (such as melphalan with prednisolone). Although its use costs more than these other treatments, this was justified by the benefits it provided.
NICE recommended that bortezomib should only be offered to people who cannot take thalidomide. This is because although bortezomib works as well as thalidomide it costs more.
The recommendations in this guidance represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, health professionals are expected to take this guidance fully into account, alongside the individual needs, preferences and values of their patients. The application of the recommendations in this guidance is at the discretion of health professionals and their individual patients and do not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.
Commissioners and/or providers have a responsibility to provide the funding required to enable the guidance to be applied when individual health professionals and their patients wish to use it, in accordance with the NHS Constitution. They should do so in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.