The National Institute for Health and Care Excellence (NICE) has issued draft negative guidance for ixazomib (Ninlaro®) in combination with lenalidomide (Revlimid®) as a treatment for relapsed and/or refractory myeloma patients who have received at least one previous line of treatment. Ixazomib, the first oral proteasome inhibitor to be made available, was granted a licence by the European Medicines Agency (EMA) in 2016 based on data from the TORMALINE-MM1 trial. Combined with lenalidomide and dexamethasone, ixazomib improved progression-free survival by 35% compared to lenalidomide and dexamethasone alone. However, it is not clear whether it improves overall survival and until further data are available NICE does not, at present, consider ixazomib to be cost-effective. The current recommendations are out for consultation.