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IMS 2026 | Individualizing treatment selection within UK myeloma treatment pathways
Gordon Cook, MB ChB, PhD, FRCP(Glas), FRCPath, Leeds Teaching Hospitals NHS Trust, Leeds, UK, discusses the challenges of individualizing treatment selection within the UK’s line-based treatment and reimbursement framework for multiple myeloma. He highlights the importance of considering prior treatment exposure when selecting therapy, while noting the practical and health economic challenges of moving toward a more flexible and individualized treatment pathway. This interview took place at the 23rd International Myeloma Society (IMS) Annual Meeting in Glasgow, UK.
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Transcript
So by treatment compatibility model, I’m assuming the reference there is to treatment exposure to date rather than lines of treatment. And there’s been several editorials written by US physicians trying to make that argument, and it is a relevant argument. However, it’s an argument that NICE can really seem to assimilate into its way of thinking. We have quite a rigid pathway for treating myeloma in the UK, and it is based around lines of therapy...
So by treatment compatibility model, I’m assuming the reference there is to treatment exposure to date rather than lines of treatment. And there’s been several editorials written by US physicians trying to make that argument, and it is a relevant argument. However, it’s an argument that NICE can really seem to assimilate into its way of thinking. We have quite a rigid pathway for treating myeloma in the UK, and it is based around lines of therapy. And the problem is that we’re now in an era where pretty much everybody will get a quadruplet drug exposure in first-line treatment. Now, how do you factor that in to second-line treatment becomes quite difficult. And, for example, at the moment, third-line treatment in myeloma has become a vacuum because of how we treat first-line in particular. So trying to adapt the indications of therapy to prior exposure clinically is sensible, but from an operational point of view is very difficult to work in the UK because we are a publicly funded healthcare system. It’s different if you’re an insurance-based system where you can get to use whatever drug you want where you feel it’s most clinically appropriate. That doesn’t work. The UK public need to get value for money, and that becomes quite difficult to then factor into a more clinically-driven fluid model, which is what you’ve asked in this question. So I think we’re quite a way off yet, but I do think clinically it is important. Look, one size does not fit all in myeloma, and that’s quite clear. We’ve got an expanding, ever-expanding therapeutic landscape, and trying to find the right drug combination for each patient at each stage of their treatment is what I want to do. It’s just not what I’m allowed to do. And I think we’re quite a bit off getting reimbursement authorities to understand that. It becomes quite hard to work out the health economics in that setting. Hard doesn’t mean saying you can’t do it.
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