Ever since FDA Advisers rejected Avastin’s (bevacizumab’s) indication for metastatic breast cancer in 2010, a controversy among health care professionals has grown. In fact, according to a small international survey carried out by researchers in Dubai, Spain and the USA, nearly half of all doctors would continue using Avastin for some of their patients, despite what the FDA’s final ruling might be.

Asim Jamal Shaikh MD, from the Department of Medical Oncology, Dubai Hospital, Dubai, United Arab Emirates, and colleagues carried out a survey to find out whether an FDA ruling on Avastin might affect how health care professionals treating women with metastatic breast cancer pursue treatment.

The researchers sent out emails from a 3,000 database held by the United Arab Emirates Cancer Congress. They excluded anybody who worked for Genentech or Roche, the makers and marketers of Avastin.

The survey, which was divided into three parts, consisted of 22 questions. The investigators gathered various types of data, including respondents’ demographic profile, what they thought of the FDA’s decision, and how they typically used Avastin in the community in the setting of metastatic breast cancer (MBC).

Below are some highlighted data from their findings:

  • 564 respondents were used for the final analysis (18.8% response rate)
  • 14.6% were from the USA, 31.1% from Europe, 7.8% from Canada, 2% United Arab Emirates, 11.1% Asia, and 33.3% RoW (rest of world)
  • Most of them thought the FDA decision would be bad for future MBC drugs
  • The majority of them thought the FDA decision was driven by cost
  • Most respondents thought progression-free survival was “a surrogate for overall survival”
  • 46.4% of them said they would continue using Avastin for triple receptor-negative MBC
  • 44.7% said they would use Avastin in a first-line setting
  • 51.9% said they would use Avastin in together with Paclitaxel

The authors concluded:

“Our survey results highlight the discord between the opinion of community oncologists and the FDA’s recent decision to withdraw the indication of bevacizumab for MBC.”

Avastin, molecular formula C6638H10160N1720O2108S44, generic name Bevacizumab, is a medication that stops the growth of new blood cells that feed cancer cells (angiogenesis). It is widely used for various cancer therapies apart from breast cancer, including colorectal, kidney, and lung cancers, as well as glioblastomas.

Initially, Avastin was thought to slow down metastatic (advanced) breast cancer by nearly six months. However, recent studies showed the disease was only slowed by two or three months at the most.

These lower figures regarding the advantages for advanced breast cancer, plus the side effects associated with the medication, which include stomach and intestinal ulcers and blood clots, prompted an FDA advisory panel to change its recommendations for the drug.

The FDA has not finalized its decision yet. However, as it usually goes along with an Advisory Panel’s recommendations, several insurers in the USA have already decided not to pay the $8,000-per-month costs of Avastin treatment. However, CMS (Centers for Medicare and Medicaid Services) say they have no intention of stopping cover.

The challenge is only related to Bevacizumab’s use with breast cancer, not with brain, kidney or other cancers.

Written by Christian Nordqvist