NICE recommends Pfizer's Elrexfio for relapsed and refractory multiple myeloma treatment

The National Institute for Health and Care Excellence (NICE) has recommended Pfizer’s Elrexfio (elranatamab) for managed access to treat relapsed and refractory multiple myeloma in adults. This recommendation allows the BCMA-directed bispecific antibody to be available through the NHS in England via the Cancer Drugs Fund (CDF) while more data on its efficacy is collected.

Patients who are eligible for Elrexfio treatment must have undergone at least three lines of therapy, including an immunomodulatory drug, a proteasome inhibitor, and an anti-CD38 antibody, and must have shown disease progression on their last treatment. This final recommendation from NICE was influenced by positive results from the MagnetisMM-3 study, which is a mid-stage clinical trial.

The MagnetisMM-3 study’s findings, with more than two years of follow-up, revealed that Elrexfio had an objective response rate of 61%. Additionally, the median overall survival for patients on Elrexfio was 24.6 months, and the median progression-free survival was 17.2 months.

Multiple myeloma, an incurable cancer arising from plasma cells in the bone marrow, impacts around 5,000 individuals annually in England. The disease typically affects multiple areas of the body and follows a relapsing-remitting pattern, necessitating further treatment after periods of remission.

Elrexfio is administered as a subcutaneous injection. It is designed to aid the immune system in identifying and eliminating cancer cells by binding to BCMA, which is highly expressed in multiple myeloma, and CD3 receptors on T cells. NICE estimates that over 700 people in England are now eligible for this treatment.

Previously, NICE had recommended Elrexfio in draft guidance published in July, with the stipulation that it should only be used if pomalidomide plus dexamethasone would have otherwise been offered. However, in the latest decision, NICE has removed this restriction.

Ruhe Chowdhury, Pfizer UK’s oncology medical director, expressed satisfaction with the updated decision, stating: “We are pleased that NICE has reviewed its earlier position and taken the decision to recommend Elrexfio without the pomalidomide plus dexamethasone restriction, meaning more patients will now be able to access the treatment via the NHS rather than just a select few.”

Chowdhury emphasized the importance of this decision due to the relapsing and remitting nature of multiple myeloma, noting that patients often require additional treatment options as their disease progresses and becomes resistant to previous therapies.