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Briefing note bevacizumab (Avastin)

What is bevacizumab used for?

Bevacizumab can be used to treat advanced epithelial ovarian, fallopian tube, or primary peritoneal cancer. Cancer of the ovaries (female reproductive organs) commonly starts in cells of the surface lining the ovaries called the epithelium and this type is known as epithelial ovarian cancer. Cancer can also affect other parts of the female reproductive system such as the fallopian tubes (tubes that link the ovaries to the womb). Cancer occurring in the lining of the abdomen (peritoneum) is known as primary peritoneal cancer and this rare cancer behaves in a similar way to epithelial ovarian cancer.  Patients are initially treated with platinum-based medicines.  In some women the cancer fails to respond and this is described as platinum-resistant disease.

How does it work?

Cancer chemotherapy is given to try and kill cancer cells or stop them spreading further. Bevacizumab is a type of medicine called a monoclonal antibody . It is given in combination with other cancer chemotherapy medicines. It binds to and blocks a protein called vascular endothelial growth factor (VEGF), which helps cancer cells grow new blood vessels. As a result, the cancer cells cannot develop their own blood supply and are starved of oxygen and nutrients, helping to slow down the growth of tumours. Bevacizumab is given as an intravenous infusion (via a drip).

What has SMC advised?

SMC has accepted bevacizumab for restricted use in the treatment of adult patients with platinum-resistant recurrent epithelial ovarian, fallopian tube, or primary peritoneal cancer who received no more than two prior chemotherapy regimens and who have not received prior therapy with bevacizumab or other VEGF inhibitors or VEGF receptor-targeted agents. SMC has restricted its use to in combination with paclitaxel only.

  • What is the evidence to support this advice?
  • A study showed that the addition of bevacizumab to chemotherapy increased the duration of survival without progression of cancer in patients with platinum-resistant ovarian cancer.
  • This use of bevacizumab met SMC ultra-orphan criteria. As part of the ultra-orphan decision making framework  (which allows the Committee to consider the wider impact that treatment may have), an economic analysis compared bevacizumab in combination with paclitaxel versus paclitaxel alone for the treatment of platinum resistant recurrent epithelial ovarian, fallopian tube, or primary peritoneal cancer. There were a number of weaknesses in the economic analysis, however as bevacizumab is an ultra-orphan medicine, SMC can accept greater uncertainty in the economic case.
  • This advice takes account of the views expressed at a Patient and Clinician Engagement (PACE)  meeting. Participants highlighted that bevacizumab has been shown to double progression free survival in this group of highly symptomatic patients, and is also associated with an overall survival benefit.  Such improved symptom control and delay in progression of the disease was said to be greatly valued by patients and their families.
  • Bevacizumab also met some of the criteria that SMC can take into consideration in reaching a decision (known as modifiers). These were: that it is an ultra-orphan medicine (a medicine for a very rare condition) and that it gives a substantial improvement in quality of life.

Using its ultra-orphan decision making framework, after consideration of the output from the PACE meeting and after application of the appropriate modifiers SMC has accepted bevacizumab for restricted use in NHSScotland because it is an effective treatment that offers additional patient benefits. This SMC advice is dependent upon the continuing availability of the PAS  or a list price that is equivalent or lower.