Title: Belantamab mafodotin for treating relapsed or refractory multiple myeloma after 4 or more therapies [ID2701]
Funder: Department of Health and Social Care

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. _x000D_ _x000D_ Approximately 5,000 people are diagnosed with multiple myeloma in England each year (2016 to 2018 data).[1] Five-year prevalence of multiple myeloma in the UK is 26 per 100,000.[2] It is most frequently diagnosed in older people, with 43% of new cases of multiple myeloma in England in people aged 75 years or older.[1] The 5-year survival rate for adults with multiple myeloma in England and Wales is estimated to be 52%.[3] Multiple myeloma is more common in men than in women and the incidence is also reported to be higher in people of African and Caribbean family background.[4]_x000D_ _x000D_ The main aims of therapy are 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. _x000D_ _x000D_ For people who have had at least 2 prior therapies:_x000D_ _x000D_ • NICE technology appraisal guidance 171 recommends lenalidomide plus dexamethasone as a treatment option for people who have had at least 2 previous therapies. _x000D_ • NICE technology appraisal guidance 380 recommends panobinostat plus bortezomib and dexamethasone as a treatment option for adults who have had at least 2 previous therapies including bortezomib and an immunomodulatory agent._x000D_ • NICE technology appraisal guidance 505 recommends ixazomib citrate plus lenalidomide and dexamethasone for use within the Cancer Drugs Fund as a treatment option for adults who have had 2 or 3 previous therapies._x000D_ _x000D_ For people who have had at least 3 prior therapies:_x000D_ _x000D_ • NICE technology appraisal guidance 427 recommends pomalidomide plus low-dose dexamethasone as a treatment option for adults who have had at least 3 previous treatments including both lenalidomide and bortezomib._x000D_ • NICE technology appraisal guidance 783 recommends daratumumab monotherapy for use as a treatment option for adults who have had 3 previous therapies including a proteasome inhibitor and an immunomodulator._x000D_ • NICE technology appraisal guidance 658 recommends isatuximab plus pomalidomide and dexamethasone for use within the Cancer Drugs Fund as a treatment option for adults who have had at least 3 previous treatments including both lenalidomide and a proteasome inhibitor._x000D_ _x000D_ Treatment options for people who have had at least 4 therapies are limited and will vary depending on a number of factors, such as response to prior treatments. People who have had at least 4 therapies can have pomalidomide plus dexamethasone (NICE technology appraisal guidance 427), and panobinostat with bortezomib and dexamethasone (NICE technology appraisal guidance 380). Other drug combinations that people who have had at least 4 therapies can have include a combination of chemotherapy with or without a steroid and with or without thalidomide as well as enrolment into clinical trials and compassionate use schemes. _x000D_ _x000D_ References_x000D_ 1. Cancer Research UK, Myeloma incidence statistics. Accessed May 2022._x000D_ 2. United Kingdom Fact sheet, International Agency for Research on Cancer. Accessed May 2022. _x000D_ 3. Cancer Research UK, Myeloma survival statistics. Accessed May 2022._x000D_ 4. Cancer Research UK, Myeloma statistics. Accessed May 2022.

Lay abstract: To appraise the clinical and cost effectiveness of belantamab mafodotin within its marketing authorisation for treating relapsed or refractory multiple myeloma after 4 or more therapies.

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