2 The technology
2.1 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. Bevacizumab in combination with capecitabine has a marketing authorisation for 'first-line treatment of patients with metastatic breast cancer in whom treatment with other chemotherapy options including taxanes or anthracyclines is not considered appropriate. Patients who have received taxane and anthracycline-containing regimens in the adjuvant setting within the last 12 months should be excluded from treatment with bevacizumab in combination with capecitabine'.
2.2 The summary of product characteristics lists the following adverse reactions that may be associated with bevacizumab treatment: gastrointestinal perforations, fistulae, wound healing complications, hypertension, proteinuria, arterial and venous thromboembolism, haemorrhage, pulmonary haemorrhage/haemoptysis, congestive heart failure, reversible posterior leucoencephalopathy syndrome, hypersensitivity/infusion reactions, osteonecrosis of the jaw, ovarian failure and neutropenia. For full details of adverse reactions and contraindications, see the summary of product characteristics.
2.3 Bevacizumab is available in 100 mg and 400 mg vials at net prices of £242.66 and £924.40, respectively (excluding VAT; 'British national formulary' [BNF] edition 63). 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. The manufacturer estimated the price of bevacizumab (excluding VAT and assuming wastage) to be £2577 for a patient weighing 72.1 kg at a dosage of 15 mg/kg every 3 weeks, amounting to an average monthly cost of £3689. Costs may vary in different settings because of negotiated procurement discounts.