Implications for service provision

Service provision is unlikely to change greatly, although there will be additional intravenous administration to cover if bortezomib use is extended.

Suggested research priorities

Head-to-head trials of combination chemotherapy regimens containing bortezomib versus regimens containing thalidomide are desirable. For the results of such a trial to be easily generalisable to UK clinical practice drug doses and treatment periods should reflect those in widespread use in the UK. All trials of first-line therapy for MM in patients who are ineligible for HDT and SCT should include assessments of patient HRQoL in response to treatment.

The patients in the RCTs included in the clinical effectiveness review received a variety of second-line and subsequent treatments. This does not reflect current UK practice, which is that most patients receive bortezomib as their second-line therapy. If research is conducted to assess the impact of second-line treatments on patient outcomes it would also be desirable to assess whether the sequence of treatment, for example first-line therapy with a thalidomide-containing regimen followed by second-line treatment with a bortezomib-containing regimen, or vice versa, has any impact on patient outcomes.