Title: Daratumumab (with bortezomib and dexamethasone) for treating relapsed, refractory multiple myeloma [ID974]
Funder: Department of Health and Social Care

Abstract: To appraise the clinical and cost effectiveness of daratumumab in combination with bortezomib and dexamethasone, within its marketing authorisation, for treating relapsed or refractory multiple myeloma.

Lay abstract: Multiple myeloma is a form of cancer that arises from plasma cells (a type of white blood cell) in the bone marrow. Myeloma cells produce large quantities of an abnormal antibody, known as paraprotein. Unlike normal antibodies, paraprotein has no useful function and lacks the capacity to fight infection. Myeloma cells supress the development of normal blood cells that are responsible for fighting infection (white blood cells), carrying oxygen around the body (red blood cells), and blood clotting (platelets). The term multiple myeloma refers to the presence of more than one site of affected bone at the time of diagnosis. People with multiple myeloma can experience bone pain, bone fractures, tiredness (due to anaemia), infections, hypercalcaemia (too much calcium in the blood) and kidney problems. In 2014, 5,501 people were diagnosed with multiple myeloma in England.(1) Of people diagnosed in the UK, 59% are aged 70 years and over. Multiple myeloma is more common in men than in women and the incidence is also reported to be higher in people of African family origin.(2) The 5-year survival rate for adults with multiple myeloma in England and Wales is about 47%.(3) Multiple myeloma is an incurable disease. Therapy aims to prolong survival and maintain a good quality of life by controlling the disease and relieving symptoms. If the disease progresses after initial treatment, the choice of subsequent therapy is influenced by previous treatment and response to it, duration of remission, comorbidities and patient preference. For people with relapsed or refractory disease after at least 1 previous treatment: • NICE technology appraisal guidance 129 recommends bortezomib monotherapy as an option for people who are at first relapse having had 1 prior therapy and who have undergone, or are unsuitable for bone marrow transplantation. • NICE technology appraisal guidance 457 recommends carfilzomib in combination with dexamethasone as an option for treating multiple myeloma in adults, only if they have had only 1 previous therapy, which did not include bortezomib • NICE technology appraisal guidance 171 recommends lenalidomide in combination with dexamethasone as an option for the treatment of multiple myeloma in people who have received 2 or more prior therapies. • NICE technology appraisal guidance 380 recommends panobinostat in combination with bortezomib and dexamethasone as a treatment option for people with relapsed and refractory multiple myeloma who have received at least 2 prior therapies including bortezomib and an immunomodulatory agent. • NICE technology appraisal guidance 427 recommends pomalidomide in combination with dexamethasone for treating multiple myeloma in adults at third or subsequent relapse References 1 Cancer Research UK ‘Myeloma incidence by sex and UK region’. Accessed July 2017. 2 Cancer Research UK ‘Myeloma incidence’. Accessed May 2016. 3 Cancer Research UK ‘Myeloma survival’. Accessed May 2016.

Research activity codes: 6.1 PHARMACEUTICALS
Health categories: CANCER AND NEOPLASMS