NICE turns down Avastin for use with chemotherapy drug

Breast cancer drug rejected despite NHS London agreeing to fund it last week

The National Institute for Health and Clinical Excellence (NICE) has today turned down a breast cancer drug for use in combination with the chemotherapy drug capecitabine.

The healthcare guidance body has opened a consultation on draft guidance which does not recommend bevacizumab (Avastin) for the first-line treatment of metastatic breast cancer when used in conjunction with capecitabine.

NICE said that although treatment with both drugs was proven to extend the point at which cancers began to progress again by 2.9 months compared to treatment with capecitabine alone, it was unclear whether that translated into an improvement in overall survival rates.

It added that clinical effectiveness evidence submitted to the Independent Appraisal Committee also included no data to show whether patients would have a better quality of life if treated with both drugs rather than with chemotherapy alone.

It said that considering these uncertainties as well as the "high cost" of Avastin, the committee concluded it was not a good use of NHS resources.

Sir Andrew Dillon, chief executive of NICE, 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.”

However, last week NHS London agreed to fund Avastin for women with a certain type of aggressive and advanced breast cancer who apply through a special cancer drugs fund set up by the Government.

Women in London who develop breast cancer which is known as “triple negative” and have received a taxane – a type of drug that blocks cell growth – when their disease was in early stage will now qualify for NHS-funded Avastin.

A spokeswoman for NICE said: “Until we publish our final guidance then local NHS bodies are free to make their own decisions.”

The guidance is now open for consultation and NICE told Health Insurance it hopes to publish the final version in August.

NICE has published several other appraisals of Avastin in the past, including one last year which turned it down for use with a different chemotherapy drug.

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