1.1 Ixazomib, with lenalidomide and dexamethasone, is recommended for use within the Cancer Drugs Fund as an option for treating multiple myeloma in adults only if:
they have already had 2 or 3 lines of therapy and
the conditions in the managed access agreement for ixazomib are followed.
1.2 This recommendation is not intended to affect treatment with ixazomib 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 clinician consider it appropriate to stop.
Why the committee made these recommendations
Ixazomib, with lenalidomide and dexamethasone, has a marketing authorisation to treat multiple myeloma in people who have already had 1 or more lines of therapy. But it is likely to be used only for people who have already had 2 or 3 lines of therapy, for whom current treatment is lenalidomide plus dexamethasone, so the appraisal focused on this population.
The main clinical trial is ongoing. For people who have already had 2 or 3 lines of therapy, ixazomib (with lenalidomide and dexamethasone) increases the length of time they live without their disease progressing, when compared with lenalidomide plus dexamethasone alone. It is not yet clear whether ixazomib (with lenalidomide and dexamethasone) prolongs life compared with lenalidomide plus dexamethasone alone, but the initial results are promising.
Ixazomib does not meet NICE's criteria to be considered a life-extending treatment at the end of life.
Ixazomib has the potential to be cost effective for people who have had 2 or 3 lines of therapy, at the price agreed in a commercial access agreement as part of the managed access agreement. But more evidence is needed to address the clinical uncertainties. It can therefore be recommended for use within the Cancer Drugs Fund while further data are collected from the clinical trial, and through the Systemic Anti-Cancer Therapy dataset.