The National Institute for Health and Clinical Excellence (NICE) has released draft guidance which recommends the drugs bortezomib and thalidomide as first-line therapies for some patients with multiple myeloma, a type of cancer that affects cells in the bone marrow.

Thalidomide may be used in patients who are not eligible for high-dose chemotherapy with stem cell transplantation.

Bortezomib (Velcade) is recommended as a treatment option for patients who are unable to tolerate, or have contraindications to, thalidomide.

Both drugs must be given in combination with an alkylating agent and a corticosteroid.

NICE's independent Appraisal Committee reached its decision after hearing evidence that the two treatments are similar in terms of their clinical effectiveness but that, at around £2,100 per treatment cycle, thalidomide is more cost-effective than bortezomib, which costs around £3,000 per cycle.

However, committee members listened to advice from experts who said that, while thalidomide is likely to be suitable for most patients, some are unable to take the drug and should therefore be allowed to take bortezomib instead.

Dr Carole Longson, director of the institute's Health Technology Evaluation Centre, said: "We are pleased to be able to provisionally recommend these two treatments for people with multiple myleloma.

"The evidence clearly showed that both thalidomide and bortezomib regimens are more effective at delaying disease progression and improving patients' life expectancy than the current treatment of an alkylating agent and corticosteroid alone."

Hilary Tovey, policy manager at Cancer Research UK, said: "We're pleased that NICE has recommended both the drugs thalidomide and Velcade for the treatment of multiple myeloma. It shows good progress is being made in tackling a type of cancer which has historically been difficult to treat."

The draft guidance is now open for consultation and final guidance is expected to be published in September 2010.