Belantamab mafodotin plus pomalidomide and dexamethasone can be used as an option to treat multiple myeloma in adults, if:
they have only had 1 line of treatment and that contained lenalidomide, and
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.
This recommendation is not intended to affect treatment with belantamab mafodotin plus pomalidomide and dexamethasone 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.
Belantamab mafodotin plus pomalidomide and dexamethasone must be funded in the NHS in England for the condition and population in the recommendations. It must be funded in England within 90 days of final publication of this guidance.
There is enough evidence to show that belantamab mafodotin plus pomalidomide and dexamethasone 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.
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:
carfilzomib plus dexamethasone
daratumumab plus bortezomib and dexamethasone
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:
carfilzomib plus dexamethasone
daratumumab plus bortezomib and dexamethasone
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.