Bevacizumab in combination with a taxane for the first-line treatment of metastatic breast cancer

Bevacizumab (Avastin, Roche) is a humanised anti-vascular endothelial growth factor (VEGF) monoclonal antibody that inhibits VEGF-induced signalling and inhibits VEGF-driven angiogenesis. This reduces vascularisation of tumours, thereby inhibiting tumour growth. Bevacizumab is administered by intravenous infusion. The recommended dose is 10 mg/kg body weight given once every 2 weeks or 15 mg/kg body weight given once every 3 weeks. Bevacizumab in combination with paclitaxel or docetaxel has a marketing authorisation for 'first-line treatment of patients with metastatic breast cancer'.

The summary of product characteristics (SPC) lists the following adverse effects that may be associated with bevacizumab treatment: gastrointestinal perforations, fistulae, wound healing complications, hypertension, proteinuria, arterial and venous thromboembolism, haemorrhage, pulmonary haemorrhage or haemoptysis, congestive heart failure, reversible posterior leucoencephalopathy syndrome and neutropenia. For full details of side effects and contraindications, see the SPC.

Bevacizumab is available in 100-mg and 400-mg vials at net prices of £242.66 and £924.40, respectively (excluding VAT; BNF, edition 59). The acquisition cost of bevacizumab (excluding VAT and assuming wastage) for a patient weighing 70 kg is £1,652.38 at a dosage of 10 mg/kg every 2 weeks and £2,576.78 at a dosage of 15 mg/kg every 3 weeks. This amounts to an average monthly cost of £3,304.76 at a dosage of 10 mg/kg every 2 weeks and £3,435.70 at a dosage of 15 mg/kg every 3 weeks. Costs may vary in different settings because of negotiated procurement discounts.