A recent poll by MDoutlook¹ concluded that payer coverage would have a significant role in bevacizumab’s use in metastatic breast cancer. Usage of the drug could be cut by two-thirds in the United States and by one-third outside the United States. The NCCN has kept its recommendation of bevacizumab with paclitaxel in their guidelines, which are an important metric for private payer coverage decisions.

Chair of the NCCN Guidelines Panel for Breast Cancer, Robert Carlson, MD, told The ASCO Post that after deliberating on the issue, the panel found no compelling evidence to alter it recommendations. “The data from the E2100 study really had not changed, so if the data were compelling 2 years ago, they are compelling enough today,” said Dr. Carlson.

Dr. Carlson offered that FDA’s decision is defensible given the modest activity seen with bevacizumab. However, he explained, the agency has historically approved drugs showing prolonged progression-free survival but no overall survival advantage in breast cancer.

“If NCCN decided progression-free survival was not a worthwhile metric for a new drug, we would go back and apply the same metric for all other drugs. And if you do that in metastatic breast cancer, you end up with only a couple of drugs, because most have not shown a clear quality-of-life advantage or meaningful difference in overall survival,” Dr. Carlson said, adding, “It is important to take a patient-centric approach when asking these questions.” ■

Disclosure: Dr. Carlson’s institution has received funds from Genentech for participation in a multi-institutional trial of which he is the Stanford principal investigator.

Reference

1. Oncology Business Review: Immediate market feedback and global clinical impact of the FDA’s revocation of Avastin in metastatic breast cancer. Available at http://bit.ly/uhkp7G. Accessed December 21, 2011.