Will U.K. watchdogs change their minds on Avastin in ovarian cancer?

The U.K.'s cost-effectiveness police have been arresting Roche's ($RHHBY) Avastin development efforts once again. As Cover magazine reports, the National Institute for Health and Clinical Excellence has nixed two proposed uses for the drug in ovarian cancer, one of the hardest-to-treat forms of the disease.

NICE recently rejected Avastin in combination with gemcitabine and carboplatin to treat recurrent, advanced ovarian cancer. Earlier this year, the agency turned down Avastin for metastasized ovarian cancer in combination with paclitaxel and carboplatin.

In the most recent case, NICE said it was stymied by Roche's failure to provide clinical trial data on about one-third of participants. That data--which probably was missing because patients had dropped out or were lost in follow-up, the agency noted--might have affected progression-free survival rates. "The committee also couldn't be sure the drug would help people live longer," NICE chief Sir Andrew Dillon said in a statement at the time.

So Avastin's proven benefits aren't worth the £25,000 cost of one course of treatment, Dillon said. "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," Dillon said (as quoted by Cover). "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."

Roche typically tries to sway the agency in these cases, and it says it will continue to work with NICE to get Avastin to cancer patients. Whether that means the company plans to offer some sort of ovarian-cancer discount remains to be seen. A final decision on both indications is expected later this year.

In the past, NICE hasn't been very receptive to broader Avastin use. The Roche drug has been stiff-armed at the agency multiple times, for uses in breast cancer, colorectal cancer and kidney cancer. Despite its repeated rejections at NICE, Avastin does have a big following among U.K. doctors. It's the drug most frequently financed by a special U.K. fund for cancer treatments NICE has refused.

The ovarian cancer use is important to Avastin's future sales growth. Roche has pinned hopes of hundreds of millions in additional sales on the new indication.

- see the Cover magazine story

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