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Talquetamab for treating relapsed and refractory multiple myeloma after 3 or more treatments

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1 Recommendations

1.1

Talquetamab should not be used to treat relapsed and refractory multiple myeloma in adults when:

  • they have had 3 or more treatments including:

    • an immunomodulatory agent

    • a proteasome inhibitor, and

    • an anti-CD38 antibody, and

  • the multiple myeloma has progressed on the last treatment.

1.2

This recommendation is not intended to affect treatment with talquetamab 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 healthcare professional consider it appropriate to stop.

What this means in practice

Talquetamab is not required to be funded and should not be used routinely in the NHS in England for the condition and population in the recommendations.

This is because there is not enough evidence to determine whether talquetamab is value for money in this population.

Why the committee made these recommendations

Teclistamab is one of the standard treatments for multiple myeloma that has relapsed (come back) and is refractory (has stopped responding to treatment) after 3 or more lines of treatment and that has progressed on the last treatment.

Talquetamab and teclistamab have not been directly compared in a clinical trial. Results from an indirect comparison with teclistamab suggest that talquetamab may increase how long people live, but this is uncertain.

There are also uncertainties in the economic model. This is because of the:

  • methods used to predict how long people in the trial would live

  • modelling of subsequent treatments and intravenous immunoglobulin use

  • impact of side effects on quality of life.

Because of the uncertainties in the clinical evidence and in the economic model it is not possible to determine the most likely cost-effectiveness estimates for talquetamab. So, it should not be used.