NICE: Breast cancer treatment does not provide enough benefit for patients to justify its cost

From today (22 August), NHS professionals are expected to follow new guidance from the National Institute for Health and Care Excellence (NICE) on the use of bevacizumab (Avastin, Roche) as a treatment for metastatic breast cancer.

Newly-published NICE guidance does not recommend the treatment (when used in combination with the chemotherapy drug, capecitabine) for the first-line treatment of metastatic breast cancer in people for whom treatment with other chemotherapy options including taxanes or anthracyclines is not considered appropriate. This recommendation has remained constant throughout the process of guidance development (which includes a thorough review of all available evidence and a public consultation) with no objections to the recommendation being raised by the manufacturer or other consultees at any stage.

Sir Andrew Dillon, NICE Chief Executive, said: “We can't recommend a drug that has not been shown to work as well as, or better than, current treatments and costs much more. Evidence presented to the independent Appraisal Committee did not conclusively show that bevacizumab, in combination with capecitabine, could improve overall survival or improve a patient's quality of life more than current treatment. These uncertainties combined with the high cost of bevacizumab mean the drug simply isn't cost-effective.

“I understand this news will be disappointing to people, especially those with breast cancer that has spread elsewhere in their body. However, NICE recommends a range of treatments that the NHS can use to treat metastatic disease and these are outlined in our clinical guideline on the diagnosis and treatment of advanced breast cancer.”


Notes to Editors

About the guidance

1. The guidance will be available from Wednesday 22 August 2012.

2. The Scottish Medicines Consortium (SMC) does not recommend bevacizumab for this indication within NHS Scotland. For more information, please visit the SMC website.

3. In 2009, NICE published a clinical guideline on the diagnosis and treatment of patients with advanced breast cancer. This guideline includes recommendations for clinicians on a range of treatment options for patients.

4. NICE has published guidance on bevacizumab for a number of conditions. In all cases, bevacizumab is not recommended for use in the NHS.

a. TA212: Bevacizumab in combination with oxaliplatin and either fluorouracil plus folinic acid or capecitabine for the treatment of metastatic colorectal cancer

b. TA214: Bevacizumab (in combination with a taxane) for the first-line treatment of metastatic breast cancer

c. TA242: Bevacizumab (in combination with non-oxaliplatin chemotherapy) for the treatment of metastatic colorectal cancer after first-line chemotherapy (review of technology appraisal 150 and part review of technology appraisal guidance 118)

d. TA118: Bevacizumab and cetuximab for the treatment of metastatic colorectal cancer

e. TA178: Bevacizumab for the first-line treatment of advanced and/or metastatic renal cell carcinoma

f. TA148: Bevacizumab for the treatment of non-small-cell lung cancer (terminated appraisal)

About NICE

1. The National Institute for Health and Care Excellence (NICE) is the independent organisation responsible for providing national guidance and standards on the promotion of good health and the prevention and treatment of ill health

2. NICE produces guidance in three areas of health:

  • public health - guidance on the promotion of good health and the prevention of ill health for those working in the NHS, local authorities and the wider public and voluntary sector
  • health technologies - guidance on the use of new and existing medicines, treatments, medical technologies (including devices and diagnostics) and procedures within the NHS
  • clinical practice - guidance on the appropriate treatment and care of people with specific diseases and conditions within the NHS.

3. NICE produces standards for patient care:

  • quality standards - these reflect the very best in high quality patient care, to help healthcare practitioners and commissioners of care deliver excellent services
  • Quality and Outcomes Framework - NICE develops the clinical and health improvement indicators in the QOF, the Department of Health scheme which rewards GPs for how well they care for patients

4. NICE provides advice and support on putting NICE guidance and standards into practice through its implementation programme, and it collates and accredits high quality health guidance, research and information to help health professionals deliver the best patient care through NHS Evidence.

This page was last updated: 21 August 2012