The UK's cost watchdog has confirmed that it is rejecting Roche's Avastin as a treatment for colorectal cancer.

The National Institute for Health and Clinical Excellence has issued final guidance on Avastin (bevacizumab) in combination with chemotherapy (oxaliplatin and either fluorouracil or capecitabine) for treating metastatic colorectal cancer. The verdict follows previous draft guidance and the drug is not recommended for use on the National Health Service in England and Wales.

NICE chief executive Andrew Dillon said the institute had recommended several drugs for various stages of colorectal cancer, including Merck KGaA's Erbitux (cetuximab) for first-line treatment. However, "the evidence we reviewed for bevacizumab in combination with chemotherapy suggests that patients receiving it for colorectal cancer may on average live for six weeks longer than patients receiving standard chemotherapy and a placebo," he added.

Sir Andrew concluded by saying that "we know how important this could be to patients and we are disappointed not to able to recommend this drug combination, but we have to be confident that its benefits justify its considerable cost". Previously he had said that using the price the NHS actually pays for oxaliplatin, the cost per QALY would actually be around £70,000 and not £25-£30,000 as suggested by Roche,” he said.

Under a proposed patient access scheme, Roche had said it would provide Avastin to the NHS at a cost of around £20,800 per patient in the first year and cover the cost of treatment thereafter (including oxaliplatin), as well as an upfront payment for each patient starting first-line treatment with the drug.

In response to this final rejection, Roche said that "due to its current restraints in methodology, NICE is unable to recommend Avastin for bowel cancer, despite it being available in virtually every other comparable country in the world." The Swiss major added that it is "keen to work with the appropriate authorities to determine the right long-term solution to access to medicines".

"In the meantime," Roche added, "doctors will have the Cancer Drugs Fund in the UK to fall back on."

Herception and Tykerb breast cancer combos turned down

NICE had some more bad news for Roche, issuing a preliminary draft guidance that recommends against funding the use of either Herceptin (trastuzumab) or GlaxoSmithKline's Tykerb (lapatinib) on the NHS in combination with an aromatase inhibitor for patients with metastatic breast cancer that is both hormone-receptor and HER2-positive.

Sir Andrew said "evidence suggests that these drug combinations do not offer enough additional value to patients over and above currently available treatment to justify the high cost." He went on to say that "although trial data indicated that these treatment combinations could delay the growth and spread of the disease, an overall survival benefit was less certain."