WHAT IS THE CADTH REIMBURSEMENT RECOMMENDATION FOR ELREXFIO?: CADTH recommends that Elrexfio should be reimbursed by public drug plans for the treatment of adult patients with relapsed or refractory multiple myeloma (MM) who have received at least 3 prior lines of therapy including a proteasome inhibitor, an immunomodulatory agent, and an anti-CD38 monoclonal antibody, and who have demonstrated disease progression on the last therapy if certain conditions are met. WHICH PATIENTS ARE ELIGIBLE FOR COVERAGE? Elrexfio should only be covered to treat patients aged 18 years and older with relapsed or refractory MM who have received at least 3 prior treatments, have disease that has not responded to their last treatment, have not received prior B-cell maturation antigen (BCMA)–targeted treatment, and are in relatively good health. Elrexfio should not be reimbursed for the treatment of those patients whose MM is affecting their brain or spinal cord or those showing signs that the tissue layers protecting the brain and spinal cord are affected by MM. It also should not be reimbursed for the treatment of those with amyloidosis (a buildup of a protein, amyloid, in organs) that is not secondary to MM, those with POEMS (polyneuropathy, organomegaly, endocrinopathy, myeloma protein, and skin changes) syndrome, and those with plasma cell leukemia. WHAT ARE THE CONDITIONS FOR REIMBURSEMENT? Elrexfio should only be reimbursed if it is prescribed and administered by health professionals at treatment centres with adequate medical resources and personnel, and if the price of Elrexfio is reduced. WHY DID CADTH MAKE THIS RECOMMENDATION? Evidence from a clinical trial demonstrated that Elrexfio may result in response to treatment, delay in the spread of cancer, and allow patients to live longer. Elrexfio may meet some patient needs because it may be an effective treatment option with manageable side effects. Based on CADTH’s assessment of the health economic evidence, Elrexfio does not represent good value to the health care system at the public list price. A price reduction is therefore required. Based on public list prices, Elrexfio is estimated to cost the public drug plans approximately $87 million over the next 3 years. However, the actual budget impact is uncertain.

ADDITIONAL INFORMATION

WHAT IS MM? MM is a cancer of plasma cells (i.e., white blood cells) in the bone marrow. In 2022, approximately 4,000 people in Canada were diagnosed with MM. UNMET NEEDS IN MM: MM is an incurable disease with a poor prognosis. MM often does not respond to initial treatments and will relapse, so the patient will need to try many different treatments. There is a need for additional treatment options that allow patients to live longer, delay the spread of cancer, improve quality of life, and reduce side effects. HOW MUCH DOES ELREXFIO COST? Treatment with Elrexfio is expected to cost approximately $28,000 per patient per 28-day cycle on a weekly dosing schedule. If patients switch to a 2-week dosing schedule after 24 weeks of treatment, 28-day treatment costs per patient are $14,000.