The UK's National Institute for Health and Clinical Excellence has rejected the use of Roche's Avastin for treating breast cancer on the grounds that the med offers "limited and uncertain benefit" for patients compared with existing treatments. Roche had calcuated the total average cost of treating a patient with Avastin plus chemotherapy is more than $52,000.
"Unfortunately, we did not receive any evidence from the manufacturer to show that (Avastin) can significantly lengthen a patient's life or, importantly, offer a better quality of life than existing treatments. Although the data seemed to show that the drug may slow the growth and spread of the cancer, the size of this effect varied between studies. Furthermore, it was extremely unclear that the benefits in terms of slowing tumour growth translated into benefits on overall survival, which is what really matters for patients," NICE chief executive Andrew Dillon says in a statement (and here is the final draft guidance).
Nonetheless, the decision casts an ominous shadow over an upcoming decision by the FDA. Last July, you may recall, an FDA advisory committee dealt Roche a blow by voting 12 to 1 to recommend the agency withdraw approval for the multibillion-dollar cancer drug for treating breast cancer. The FDA approved Avastin two years ago to fight breast cancer, but two studies - which were undertaken as a condition of approval - found patients given Avastin and chemotherpay didn’t survive longer than those given chemo alone. Avastin patients also suffered more serious side effects (look here).
The Avastin decision has stirred controversy over the yardsticks used to approve Avastin for breast cancer treatment and the FDA's accelerated approval program. For instance, one advocacy group, Breast Cancer Action, maintains the FDA placed too much emphasis on surrogate markers, specifically, progression-free survival (see this). Meanwhile, some cancer patients worry the agency will yank the med, which in some cases has been proven helfpul (look here).
1 Comment
The problem with Avastin is the same thing that was a problem with AZT for HIV/AIDS. Early results, then rapid resistance. Solution is combination therapy to attack different targets. Tumor vasculature needs VEGF to survive. Avastin removes VEGF, killing blood vessels. But other proangiogenic factors can substitute: FGF, PDGF, ephrin A1, angioprotein 1, IL-8 etc. We need to attack these other targets, as well. If you can achieve this, then you may not need the other drugs, which really don't get into the tumor so well. But angiogenic attack provides true selective toxicity, something which is sorely lacking with all of our other treatments. With cancer, it's going to take combination antivascular therapy to make a difference.