NICE draft guidance rejects bevacizumab for advanced bowel cancer

In collaboration with Adfero

The National Institute for Health and Clinical Excellence (NICE) has released draft guidance for cancer drug bevacizumab (Avastin).

It says that the drug is not recommended for the treatment of advanced (metastatic) bowel cancer. NICE says that it has made this decision because the current proposal by the manufacturer, Roche, means that the drug does not represent value for money. This decision is now open for consultation.

Bevacizumab can help shrink and remove tumours that have spread from the bowel to other parts of the body, when given alongside standard chemotherapy.

Members of the NICE Independent Appraisal Committee recognised that the drug provides additional benefit compared with existing treatments. It heard results from trials which showed that the drug could provide on average an extra six weeks of life, compared with a placebo (dummy treatment).

However, the institute's Appraisal Committee came to the conclusion that the drug would not be cost-effective, even when taking into account a revised 'patient access scheme' proposed by the drug's manufacturer Roche.

In this proposal Roche proposed to supply the drug at a cost of around £20,800 per patient for one year, after which the drug would be provided for free. Roche also said it would reimburse the NHS for the cost of the chemotherapy drug oxaliplatin, when used alongside bevacizumab.

Roche also offered to provide an additional up-front payment to the NHS for each patient starting first-line treatment with Avastin.

However, NICE has ruled that, even after taking this patient access scheme into account, it still does not consider Roche's proposal to be a cost-effective use of NHS resources. Committee members also said that the proposed patient access scheme was too complex and would be expensive to administer.

A recent study showed that some parts of the NHS are already struggling to make these schemes work in practice.

Sir Andrew Dillon, chief executive of NICE, said: "We have recommended several treatments for various stages of colorectal cancer, including cetuximab for the first-line treatment of metastatic colorectal cancer.

"We are disappointed not to be able to recommend bevacizumab as well but we have to be confident that the benefits justify the considerable cost of this drug."

NICE has previously recommended irinotecan, oxaliplatin, capecitabine, tegafur with uracil, and cetuximab for the treatment of various stages of bowel cancer.

Estimates suggest that about 6,500 patients per year would be eligible for bevacizumab.

Hilary Tovey, Cancer Research UK's policy manager, said: "This is a disappointing decision from NICE today.

"We know that the appraisal committee has found that Avastin was clinically effective as a treatment for this type of bowel cancer. It's now up to NICE and the manufacturers of this treatment to work together to reach an agreement to make this drug available to the patients who might benefit from it."

The draft NICE guidance has now been issued for consultation until September 15th, after which the committee will consider the comments and issue its next draft guidance.

Until final guidance is published by NICE it is up to local NHS bodies to make decisions about whether they will provide funding for bevacizumab for patients with metastatic bowel cancer.