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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.

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 helps block the growth of new blood vessels that supply the cancer cells with nutrients. 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 combination with carboplatin and paclitaxel, for the front-line treatment of advanced (International Federation of Gynaecology and Obstetrics (FIGO) stages IIIB, IIIC and IV) epithelial ovarian, fallopian tube, or primary peritoneal cancer. SMC has restricted its use to patients with FIGO stage IV disease.

What is the evidence to support this advice?

•A study of women with advanced ovarian cancer showed that the addition of bevacizumab to standard chemotherapy with carboplatin and paclitaxel increased the duration of survival without progression of cancer.

•An economic analysis compared bevacizumab in combination with standard chemotherapy with standard chemotherapy alone. There were a number of uncertainties with the analysis. However, in this setting bevacizumab meets the SMC criteria for an orphan-equivalent medicine so greater uncertainty in the economic case can be accepted.

•This advice takes account of the views expressed at a Patient and Clinician Engagement (PACE) Meeting. Participants expressed very strong support for this medicine, given the lack of effective treatment options for this devastating condition at this stage. The possible extended survival and good quality of life achieved with bevacizumab were said to be highly 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 orphan-equivalent medicine (a medicine for a rare condition) and that there is an absence of other treatments of proven benefit.

After considering all the available evidence, application of the appropriate modifiers and consideration of the output from the PACE meeting, SMC has accepted bevacizumab for restricted use because it is an effective treatment that may offer additional patient benefits.