Belantamab mafodotin plus bortezomib and dexamethasone can be used as an option to treat multiple myeloma in adults if:
they have only had 1 previous line of treatment, and
the company provides it according to the commercial arrangement.
This recommendation is not intended to affect treatment with belantamab mafodotin plus bortezomib 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 bortezomib and dexamethasone 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. 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 bortezomib 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 bortezomib and dexamethasone is licensed for use at second line and beyond. But for this evaluation, the company asked for it to be considered as a treatment at second line only.
Usual treatment for multiple myeloma at second line includes:
carfilzomib plus lenalidomide and dexamethasone
daratumumab plus bortezomib and dexamethasone, when lenalidomide is not an option.
Evidence from a clinical trial shows that belantamab mafodotin plus bortezomib and dexamethasone increases how long people have before their condition gets worse compared with daratumumab plus bortezomib and dexamethasone. The evidence also suggests that people live longer. But the trial is ongoing, so this is uncertain.
Belantamab mafodotin plus bortezomib and dexamethasone has not been directly compared in a clinical trial with carfilzomib plus lenalidomide and dexamethasone. An indirect comparison suggests that it is likely to work as well as carfilzomib plus lenalidomide and dexamethasone, but this is uncertain.
The cost-effectiveness estimates for belantamab mafodotin plus bortezomib and dexamethasone compared with usual treatment are within the range that NICE considers an acceptable use of NHS resources. So, it can be used at second line.