Patients to get 13 months’ remission thanks to first-of-its-kind treatment

A first-of-its-kind treatment that could give patients at second and third line remissions of over a year has been approved on the NHS in England and Wales.

A new type of treatment, SVD combines three drugs – selinexor (Nexpovio®), bortezomib (Velcade®) and dexamethasone – and can stop myeloma in its tracks for 13 months on average. 

It is aimed at people at second line, whose myeloma has become resistant to both daratumumab (Darzalex®) and lenalidomide (Revlimid®), and patients at third line, whose cancer is resistant to lenalidomide. 

Based on the latest data from the BOSTON clinical trial, 76% of patients responded well to SVD and had an average remission of over 13 months.

This latest approval means that selinexor is now available on the NHS to eligible patients at second line, third line and fifth line.

This was around four months longer than patients on bortezomib and dexamethasone alone.

This latest approval means that selinexor is now available on the NHS to eligible patients at second line, third line and fifth line.

Shelagh McKinlay, Director of Research and Advocacy at Myeloma UK, said: “This is a hard-earned victory for everyone involved and a major step in the right direction for the myeloma community. SVD’s novel mechanism of action means it can fight myeloma in a completely different way to other currently available treatments. 

“Until we have a cure, it is absolutely vital that all patients are given as many options to tackle their cancer as possible – no matter where they are on their treatment journey.”

Selinexor is a new type of drug known as a selective inhibitor of nuclear export (SINE). It tackles myeloma in a completely different way to currently approved drugs and provides an alternative for patients who have relapsed multiple times or do not respond to available treatments.

Selinexor stops a protein called Exportin 1 (XPO1) from working properly.

XPO1 is responsible for moving other proteins between different parts of the cell. Myeloma cells exploit XPO1 to get rid of proteins, called tumour suppressor proteins, which would stop them growing and multiplying.

By blocking XPO1, the tumour suppressor proteins build up within the myeloma cells, killing them.

Other important treatments for patients at third line and beyond will be making their way through NICE’s appraisal process over the coming months, including elranatamab and teclistamab.

Myeloma UK will work alongside the patient and clinical community to campaign and advocate for access to the next generation of myeloma drugs.

What does this decision mean for patients?

This approval means that eligible myeloma patients at first and second relapse (second or third line) can now receive selinexor in combination with bortezomib and dexamethasone. It gives patients whose myeloma has become resistant to previous myeloma treatments access to an innovative treatment which kills the myeloma cells in a new way.

Does this decision affect patients based in Scotland and Northern Ireland?

In Scotland, the Scottish Medicines Consortium makes decisions about which treatments to fund through the NHS. It follows a similar decision process to NICE with the pharmaceutical company, clinical experts and patient experts submitting evidence. The evidence is then reviewed and assessed by the SMC committee. The SMC appraisal of SVD is expected to take place this year.

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

When will SVD be available on the NHS?

When a treatment is recommended it should be made available to patients through the NHS within 90 days of the publication of the final decision. The final decision is officially published following the standard notice period for any appeal requests (15 working days) after NICE notifies the public of its decision.

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