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Briefing note bortezomib (Velcade)

What is bortezomib used for?

Bortezomib can be used to treat mantle cell lymphoma. Mantle cell lymphoma is a rare form of blood cancer. It starts in white blood cells in the lymphatic system (part of the body’s system for fighting infection), called lymphocytes. There are two main types of lymphocytes – B cells and T cells. Mantle cell lymphoma affects the B cells and causes abnormal ones to build up in the lymph nodes or organs of the body where they start to form tumours. Mantle cell lymphoma can be treated with chemotherapy, radiotherapy or with a stem cell or bone marrow transplant.

How does it work?

Bortezomib is an anti-cancer medicine called a proteasome inhibitor. The proteasome is a system in cells that breaks down proteins that are not needed any more. By blocking the proteasome, bortezomib prevents cancer cells from breaking down proteins that are no longer required and this causes them to die.

What has SMC advised?

SMC has accepted bortezomib for use in combination with rituximab, cyclophosphamide, doxorubicin and prednisone for the treatment of adult patients with previously untreated mantle cell lymphoma who are unsuitable for haematopoietic stem cell transplantation (HSCT).

What is the evidence to support this advice?

  • A study showed that in adults with previously untreated mantle cell lymphoma (who were unsuitable for HSCT), bortezomib in combination with rituximab, cyclophosphamide, doxorubicin and prednisone increased the duration of survival without progression of cancer more than a treatment regimen containing rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone (R-CHOP).
  • An economic analysis compared bortezomib (in combination with rituximab, cyclophosphamide, doxorubicin and prednisone) with a commonly used chemotherapy regimen. Overall it was found that the bortezomib combination offered value for money for the treatment of these patients.

SMC has accepted bortezomib for use because the balance of costs and benefits meant that it was considered to offer value for money.