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Briefing Note - pegylated liposomal doxorubicin (Caelyx)

SMC did not recommend liposomal doxorubicin in combination with bortezomib to treat patients with multiple myeloma (a cancer of the blood) who have received at least one previous treatment and who have already undergone or are unsuitable for bone marrow transplant.

  • Multiple myeloma is a rare cancer of a type of white blood cell called plasma cells. Patients with multiple myeloma have abnormally high levels of cancerous plasma cells, which can clump together to form tumours in the bone marrow (the organ that produces blood cells). These cells can affect the body’s ability to produce new blood cells, and produce high levels of abnormal antibodies (a type of protein) that cannot fight infection properly and directly affect the bone. Patients with multiple myeloma experience bone pain, can develop fractures, suffer from tiredness due to low iron levels in the blood and have repeated infections.
  • Multiple myeloma is mainly treated with drugs and radiation. Some people may benefit from a bone marrow transplant (a treatment to restore normal blood cell production). Liposomal doxorubicin is a drug which is given as a drip. It interacts with cells in such a way as to selectively kill cancer cells. The doxorubicin is enclosed in tiny spheres called pegylated liposomes which help to deliver the medicinal product from the blood stream to the cancerous tissue rather than healthy normal tissue.
  • A study has shown that liposomal doxorubicin plus another cancer therapy (called bortezomib) significantly increased the time taken for the cancer to spread compared with bortezomib alone. The combination did not lead to a significant increase in overall survival.
  • The side effects of liposomal doxorubicin plus bortezomib were consistent with the known safety profiles of both agents.
  • SMC decided not to recommend liposomal doxorubicin for use within NHSScotland because of weaknesses in the economic case put forward by the manufacturer.