Proteasome inhibitors

Bortezomib

• Powder for solution for injection vials 3.5g
• Solution for injection vials 3.5mg/1.4ml

Notes

1. NICE TA129: Bortezomib (Velcade) monotherapy is recommended as an option for the treatment of progressive multiple myeloma in people who are at first relapse having received one prior therapy and who have undergone, or are unsuitable for, bone marrow transplantation, under the following circumstances (October 2007):
   1. the response to bortezomib is measured using serum M protein after a maximum of four cycles of treatment, and treatment is continued only in people who have a complete or partial response (that is, reduction in serum M protein of 50% or more or, where serum M protein is not measurable, an appropriate alternative biochemical measure of response) and
   2. the manufacturer rebates the full cost of bortezomib for people who, after a maximum of four cycles of treatment, have less than a partial response (as defined above).
2. NICE TA228: Bortezomib (Velcade) in combination with an alkylating agent and a corticosteroid is recommended as an option for the first-line treatment of multiple myeloma (July 2011) if:
   1. high-dose chemotherapy with stem cell transplantation is considered inappropriate and
   2. the person is unable to tolerate or has contraindications to thalidomide.
3. NICE TA311: Bortezomib (Velcade) is recommended as an option within its marketing authorisation, that is, in combination with dexamethasone, or with dexamethasone and thalidomide, for the induction treatment of adults with previously untreated multiple myeloma, who are eligible for high-dose chemotherapy with haematopoietic stem cell transplantation (April 2014).
4. NICE TA370: Bortezomib (Velcade) is recommended, within its marketing authorisation, as an option for previously untreated mantle cell lymphoma in adults for whom haematopoietic stem cell transplantation is unsuitable (December 2015).

Carfilzomib

• Powder for solution for infusion vials 10mg, 30mg, 60mg

Notes

1. NICE TA657: Carfilzomib (Kyprolis) with dexamethasone is recommended as an option for treating multiple myeloma in adults (November 2020), only if:
   1. they have had only 1 previous therapy and
   2. the company provides carfilzomib according to the commercial arrangement.
2. NICE TA695: Carfilzomib (Kyprolis) plus lenalidomide (Revlimid) and dexamethasone is recommended as an option for treating multiple myeloma in adults (April 2021), only if:
   1. they have had only 1 previous therapy, which included bortezomib, and
   2. the company provides carfilzomib according to the commercial arrangement.
3. MHRA Drug Safety Update (August 2019): Carfilzomib (Kyprolis): reminder of risk of potentially fatal cardiac events.
4. MHRA Drug Safety Update (November 2019): Carfilzomib (Kyprolis): risk of reactivation of hepatitis B virus.

Ixazomib citrate

• Capsules 2.3mg, 3mg, 4mg

Notes

1. NICE TA870: Ixazomib (​Ninlaro​), with lenalidomide and dexamethasone, ​is recommended​ as an option for treating multiple myeloma in adults (February 2023), only if:
1. they have had 2 or 3 lines of therapy ​and​
2. the company provides ixazomib according to the commercial arrangement.