Roche's Avastin has added advanced breast cancer to its growing list of unsuccessful appraisals by the UK's National Institute for Health and Clinical Excellence (NICE).
The health technology assessment body ruled that Avastin (bevacizumab) does not provide enough patient benefit to justify its cost and has not recommended its use by the NHS in England.
In publishing its guidance NICE noted its consistently negative stance on Avastin in this indication had not met any objections from either Roche or other consultees at any stage of the appraisal process.
Andrew Dillon, NICE chief executive, said: “We can't recommend a drug that has not been shown to work as well as, or better than, current treatments and costs much more.
“Evidence presented to the independent Appraisal Committee did not conclusively show that bevacizumab, in combination with capecitabine, could improve overall survival or improve a patient's quality of life more than current treatment.
“These uncertainties combined with the high cost of bevacizumab mean the drug simply isn't cost-effective.”
Avastin (bevacizumab) was appraised, in combination with Roche's chemotherapy drug Xeloda (capecitabine), as a first-line treatment of metastatic breast cancer in people for whom treatment with other chemotherapy options, including taxanes or anthracyclines, are not appropriate.
The average monthly cost of using Avastin in this setting comes to around £3,690. In earlier guidance NICE's appraisal committee said the most plausible Incremental Cost Effectiveness Ratio (ICER) for Avastin was more than £82,000 per QALY gained.
The drug's role in breast cancer was brought into question last year though, after studies suggested that the risks associated with the drug outweighed its benefits in advanced breast cancer.
In the US, the FDA stripped Avastin of its approval in that indication last November, while in 2010 the EMA restricted its use to only include combination with paclitaxel. Later, the EU agency said treatment alongside Xeloda was also an option.
Although the drug was the most requested under the English Cancer Drugs Fund, NICE has consistently refused to recommend its use in any setting. The Institute's negative guidance has previously included Avastin for use in combination with a taxane for the first-line treatment of metastatic breast cancer, as well as for first-line treatment of advanced colorectal cancer.
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