The National Institute for Health and Care Excellence (NICE) has advised the NHS against funding the drug bevacizumab (Avastin, manufactured by Roche) for advanced ovarian cancer[1]. In two separate pieces of final guidance published for the health service, NICE concludes that funding the treatment on the NHS does not represent the best use of taxpayers' money.

Sir Andrew Dillon, NICE Chief Executive, said:“The NHS has finite resources so it's important that only the most cost-effective treatments - drugs that work well considering their cost and potential side-effects - are recommended.

“NICE has published guidance on two specific uses of bevacizumab as an advanced ovarian cancer treatment and we're naturally disappointed that we can't recommend it in either instance. Unfortunately, the evidence provided to the Appraisal Committee - which developed these two pieces of guidance for NICE - highlighted that, in both cases, bevacizumab was not cost-effective.”

Ovarian cancer is classed as ‘advanced' once it spreads outside a woman's ovaries. This can either be to nearby surrounding tissue (locally advanced) or more distant parts of the body (metastatic disease). Bevacizumab aims to stop the disease from spreading by targeting the tumour's blood supply (which it needs to grow and spread). However, as a result of two separate and thorough reviews of available evidence, NICE does not recommend bevacizumab:

• When used in combination with the chemotherapy drugs paclitaxel and carboplatin as a first treatment for advanced ovarian cancer.
• When used with carboplatin and gemcitabine to treat the first recurrence of advanced ovarian cancer if it has returned six months or more after initial treatment with platinum-based chemotherapy (platinum-sensitive disease).

Despite the negative recommendations, both guidance documents do say that women with advanced ovarian cancer already receiving bevacizumab as part of one of these treatment combinations can continue until they or their doctor consider it appropriate to stop. The publication of this guidance now replaces local NHS recommendations across England and Wales.

Ends

Notes to Editors

About the guidance

• The final guidance documents will be available to view from Wednesday 22 May 2013.
• With regard to ovarian cancer, bevacizumab (Avastin) is licensed in combination with carboplatin and paclitaxel for “the front-line treatment of advanced (FIGO stages IIIB, IIIC and IV) epithelial ovarian, fallopian tube, or primary peritoneal cancer” and also in combination with carboplatin and gemcitabine for the “first recurrence of platinum-sensitive advanced ovarian cancer (including fallopian tube and primary peritoneal cancer) who have not received prior therapy with bevacizumab or other vascular endothelial growth factor (VEGF) inhibitors or VEGF receptor-targeted agents”.
• NICE has previously recommended the following as first treatment options for ovarian cancer
  • paclitaxel in combination with a platinum-based compound or platinum-based therapy alone (cisplatin or carboplatin) as alternatives for first-line chemotherapy (usually following surgery) in the treatment of ovarian cancer.
  • the choice of treatment for first-line chemotherapy for ovarian cancer should be made after discussion between the responsible clinician and the patient about the risks and benefits of the options available. In choosing between treatment with a platinum-based compound alone or paclitaxel in combination with a platinum-based compound, this discussion should cover the side-effect profiles of the alternative therapies, the stage of the woman's disease, the extent of surgical treatment of the tumour, and disease-related performance status.
• In 2005, NICE published guidance recommending the following as options for second-line (or subsequent) treatment for advanced ovarian cancer:
  • paclitaxel in combination with a platinum compound in platinum-sensitive or partially platinum sensitive disease
  • pegylated liposomal doxorubicin hydrochloride in partially platinum-resistant disease
  • single agent paclitaxel or pegylated liposomal doxorubicin hydrochloride in platinum-resistant or platinum refractory disease or for those with an allergy to platinum-based compounds
  • topotecan only where the other recommended options are considered inappropriate.

Paclitaxel in combination with a platinum-based therapy is currently seen as one of the most effective treatments for ovarian cancer and is one of the more widely-used treatment options in clinical practice.

• The Scottish Medicines Consortium (SMC) does not recommend bevacizumab for the following uses as an ovarian cancer treatment:
  • bevacizumab, when used within its licensed indication with paclitaxel and carboplatin for the treatment of advanced ovarian cancer
  • bevacizumab, in combination with carboplatin and gemcitabine, for the treatment of adults with first recurrence of platinum-sensitive epithelian ovarian, fallopian tube or primary peritoneal cancer who have not received prior therapy with bevacizumab or other VEGF inhibitors or VEGF receptor-targeted agents.

About NICE

The National Institute for Health and Care Excellence (NICE) is the independent body responsible for driving improvement and excellence in the health and social care system. We develop guidance, standards and information on high-quality health and social care. We also advise on ways to promote healthy living and prevent ill health.

Formerly the National Institute for Health and Clinical Excellence, our name changed on 1 April 2013 to reflect our new and additional responsibility to develop guidance and set quality standards for social care, as outlined in the Health and Social Care Act (2012).

Our aim is to help practitioners deliver the best possible care and give people the most effective treatments, which are based on the most up-to-date evidence and provide value for money, in order to reduce inequalities and variation.

Our products and resources are produced for the NHS, local authorities, care providers, charities, and anyone who has a responsibility for commissioning or providing healthcare, public health or social care services.

[1] This includes women with fallopian tube and primary peritoneal cancer.