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Briefing note: bevacizumab (Avastin)

What is bevacizumab used for?

Bevacizumab is used to treat a range of different types of cancer. In this submission it has been proposed as a front-line treatment, when given in combination with carboplatin and paclitaxel, for advanced (International Federation of Gynaecology and Obstetrics [FIGO] stages III B, III C and IV) epithelial ovarian, fallopian tube, or primary peritoneal cancer. Ovarian cancer is the fifth most common cause of death from cancer in women7. 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 given in combination with other cancer chemotherapy medicines. This medicine 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 once every 3 weeks as an infusion (via a drip).

What has SMC advised?

SMC has not accepted bevacizumab, in combination with carboplatin and paclitaxel, for the frontline treatment of advanced (FIGO stages III B, III C and IV) epithelial ovarian, fallopian tube, or primary peritoneal cancer.

What is the evidence to support this advice?

  • The submitting company has requested that SMC considers this product when positioned for use in patients who, after debulking surgery, have visible and palpable residual disease.
  • Studies showed that adding bevacizumab to standard chemotherapy with carboplatin and paclitaxel increased duration of survival without progression of cancer by up to 4 months. In women with stage III and residual disease after surgical debulking or stage IV disease, it increased overall survival by about 5 months.
  • An economic analysis compared bevacizumab in combination with standard chemotherapy (carboplatin and paclitaxel) versus standard chemotherapy. A number of uncertainties and limitations in the analysis were noted. 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 from a Patient and Clinician Engagement (PACE)8 meeting. Meeting attendees gave strong support for this medicine given the lack of other effective treatment options for this devastating condition.
  • Bevacizumab also met one of the criteria that SMC can take into consideration in reaching a decision (known as modifiers) as it offered a treatment option where there is the absence of other treatments of proven benefit.

SMC did not accept bevacizumab for use in NHSScotland despite the output from the PACE meeting, and the application of SMC modifiers, because after considering all available evidence, the balance of costs and benefits meant that it was not considered to offer value for money.

In May 2014, SMC introduced PACE meetings to capture evidence of the added benefits of the medicine, from both patient and clinician perspectives, that may not be fully captured within the conventional clinical and economic assessment process for medicines used at the end of life and for very rare conditions. This evidence is taken into consideration in the SMC decision. Find out more about PACE.