Elranatamab approved at fourth line and beyond

Our Senior Policy Officer, Caroline Donoghue tells us more about this decision and what it means for patients.

Today we received the brilliant news that the very first bispecific drug in the UK, elranatamab, has been approved by the National Institute for Health and Care Excellence (NICE) for use in England and Wales.

Elranatamab is a new kind of treatment which has yielded some very promising results in clinical trials and has been shown to improve remission times by more than 17 months on average.   

It will be rolled out to people at fourth line and beyond who have previously received an immunomodulatory agent such as lenalidomide (Revlimid®), a proteosome inhibitor such as bortezomib (Velcade®) or an anti-CD38 antibody like daratumumab (Darzalex®).     

As the decision comes with some restrictions as to who can access the drug, I want to take the opportunity to explain what this could mean for some patients.  

I also want to reassure you that we are already in talks with NICE, NHS England and the pharmaceutical company behind the drug, Pfizer, to find a solution for anyone who’s not eligible at the moment. 

What is elranatamab and how does it work?     

Elranatamab is a drug known as a bispecific antibody, which helps the immune system to recognise and kill cancer cells by binding to both myeloma cells and to T cells. T cells are a type of white blood cell in our immune systems. When the bispecific antibody brings them into close contact with the myeloma cells, they are able to destroy these cells.  

Data from the MagnetisMM-3 trial showed an overall response rate of 61%, while the average remission was 17.2 months.   

Elranatamab will be available through the Cancer Drugs Fund – a pot of money which provides cancer patients in England with faster access to the most promising new drugs pending full approval from NICE. After a period of three years, NICE will decide whether to make it available permanently on the NHS.     

While we are pleased to see another new drug added to the growing number of pioneering myeloma treatments, NICE’s approval comes with an unexpected restriction that limits its use and could see some patients miss out on elranatamab. 

What do we mean by restriction?  

 We were disappointed by NICE’s decision to only make elranatamab available as an alternative to pomalidomide (Imnovid®) plus dexamethasone.  

 This means that anyone who has already received treatments like IsaPD – a combination of isatuximab (Sarclisa ®), pomalidomide and dexamethasone – or pomalidomide plus dexamethasone (PD), will not be eligible for this new bispecific antibody.  

What is Myeloma UK doing and why?   

We know people with myeloma need more treatment options at their fingertips, and they need them now. We have 25 years of experience of campaigning for and delivering access to new treatments.  

This is why we are working with NICE, NHS England and the pharmaceutical company manufacturing the drug to come up with a solution and fight for wider access to elranatamab.  

For more information and updates about new treatments, please join our mailing list.

What about patients in Scotland and Northern Ireland?

In Scotland, the Scottish Medicines Consortium makes decisions about which treatments to fund through the NHS. Elranatamab is currently being appraised by the SMC. Myeloma UK is involved in this appraisal and we expect a decision later this year.

In Northern Ireland, the Department for Health makes decisions on which treatments to fund through the NHS. It can follow guidance issued by either NICE or the SMC but usually follows the guidance issued by NICE.

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