Avastin will continue not to be funded by the NHS for ovarian cancer as the drug pricing watchdog for England has again rejected its approval.

In its latest round of draft guidance NICE has said Roche’s Avastin (bevacizumab) is not recommended as an NHS treatment for a type of recurrent, advanced ovarian cancer.

This latest decision, which has been produced following a public consultation on earlier initial recommendations against the drug, again concluded that Avastin - when used with the chemotherapy drugs, Lilly’s Gemzar (gemcitabine) and carboplatin - does not represent good value for money for the NHS.

Sir Andrew Dillon, NICE’s chief executive, explained: “Although the independent appraisal committee acknowledged that bevacizumab may help to delay a person’s cancer from spreading for a few months, it noted that clinical trial data was unavailable for around one in three trial participants, possibly due to discontinuation of treatment, side-effects or because they had been lost to follow-up, making it difficult to know what effect this had on progression-free survival rates.

“The committee also couldn’t be sure the drug would help people live longer. The current evidence of benefit for patients does not support the cost of the treatment, which the manufacturer estimates to be just over £25,000 for one course for an average patient.”

But the draft guidance goes on to recommend that people currently receiving this treatment combination should be able to continue until they and their clinician consider it appropriate to stop.

The Institute is also developing recommendations on the use of this drug to treat the first recurrence of advanced ovarian cancer if it has returned six months or more after initial treatment and if the person has previously received platinum-based chemotherapy (platinum-sensitive disease). The draft guidance is also relevant to women with fallopian tube and primary peritoneal cancer.

Consultees now have an opportunity to appeal against the draft recommendations – if none are forthcoming, then final guidance will be published next month.

But it looks likely to come to the same conclusion as its counterpart the Scottish Medicines Consortium which in October said the treatment’s cost in relation to its health benefits was not sufficient, and it said the firm failed to “present a sufficiently robust economic analysis to gain acceptance”.

Avastin and the Cancer Drugs Fund

Currently, NICE does not recommend the use of Avastin for any of its five European licences, which includes indications for colorectal and lung cancers. 

It remains the most commonly funded drug via England’s Cancer Drugs Fund, which injects an extra £200 million a year into the NHS to pay for new oncology treatments that have not been recommended by the watchdog, or is under assessment.

This is set to end next April, however, and Roche has said that there is still uncertainty over the future for new patients in the UK who want to receive Avastin after next spring.

Speaking to PharmaTimes before his departure last month, the former chair of NICE Sir Michael Rawlins acknowledged Avastin’s top spot in the CDF, but said it was right that NICE didn’t recommend as the drug’s “benefits are small and its price is very high”. He added that the creation of the Fund was clearly a “political decision” by the coalition government, but would not go as far to criticise its implementation.