NICE turns down Roche breast cancer drug Avastin, citing too many uncertainties

UK drug watchdog the  National Institute for Health and Clinical Excellence (NICE), said this morning that it has opened a consultation on new, draft guidance which does not recommend Avastin (bevacizumab), from Swiss drug major Roche (ROG: SIX), for the first-line treatment of metastatic breast cancer, when used in combination with the chemotherapy drug, capecitabine.

The NICE said that clinical effectiveness evidence submitted to the Independent Appraisal Committee compared bevacizumab (in combination with capecitabine) with capecitabine (plus placebo). The committee concluded that, although the median progression-free survival benefit associated with bevacizumab plus capecitabine was 2.9 months more than capecitabine monotherapy, it was unclear whether that benefit translated into an improvement in overall survival. There was also no data to show if patients would have a better quality of life than if they were treated with chemotherapy alone - an important issue raised during the appraisal. Bearing in mind these uncertainties combined with the high cost of bevacizumab, the committee concluded this treatment was not a good use of limited National Health Service resources.

Sir Andrew Dillon, NICE Chief Executive, said: “We understand the need for effective treatments that can help patients live for as long as possible with a good quality of life. However, the evidence submitted to our independent appraisal committee did not conclusively show that bevacizumab could do either. The cost-effectiveness of the treatment was also an issue; 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. We want to ensure people have access to the best treatments the NHS can afford; bevacizumab has so far not been proven to be clinically or cost-effective.”