This systematic review conducted by researchers with the NHS Health Technology Assessment (HTA) programme examined the clinical- and cost-effectiveness of bortezomib or thalidomide in combination chemotherapy regimens with an alkylating agent and a corticosteroid for the first-line treatment of multiple myeloma.

A search for literature was conducted from 1999 to 2009, and 40 references were identified for the systematic review of clinical effectiveness. Five RCTs met the inclusion criteria for the review: one RCT evaluated bortezomib in combination with melphalan and prednisolone/prednisone (VMP), three evaluated thalidomide in combination with melphalan and prednisolone/prednisone (MPT) and one evaluated thalidomide in combination with cyclophosphamide and attenuated dexamethasone (CTDa). The comparator in all of the included trials was with melphalan and prednisolone/prednisone (MP).

The review found that:

• VMP and MPT can both be considered more clinically effective than MP for the first-line treatment of MM in people for whom high-dose therapy and SCT would not be appropriate.

• CTDa was more effective than MP in terms of complete response but data on survival outcomes did not meet the inclusion criteria.

• Cost-effectiveness analysis indicated that MPT has a greater probability of being cost-effective than either VMP or CTDa.

This review concluded from these data that “service provision is unlikely to change greatly. As uncertainties remain, further research is needed regarding the use of bortezomib- and thalidomide-containing combination regimens. Head-to-head trials of bortezomib- and thalidomide-containing combination regimes are required, including assessments of patient HRQoL in response to treatment.”