2 The technology
2.1 Bevacizumab (Avastin, Roche) is a humanised monoclonal antibody that inhibits both vascular endothelial growth factor (VEGF)-induced signalling and VEGF-driven angiogenesis. This reduces vascularisation of tumours, thereby inhibiting tumour growth. Bevacizumab is administered by intravenous infusion. Bevacizumab in combination with carboplatin and paclitaxel has a UK marketing authorisation for 'the front-line treatment of advanced (International Federation of Gynaecology and Obstetrics [FIGO] stages IIIB, IIIC and IV) epithelial ovarian, fallopian tube or primary peritoneal cancer'. The licensed dose is 15 mg/kg body weight given once every 3 weeks in addition to carboplatin and paclitaxel for up to 6 cycles of treatment, followed by continued use of bevacizumab as single agent until disease progression, or for a maximum of 15 months, or until unacceptable toxicity is reached, whichever occurs earlier.
2.2 The summary of product characteristics lists the following adverse reactions that may be associated with bevacizumab treatment: gastrointestinal perforations, fistulae, wound healing complications, hypertension, proteinuria, arterial and venous thromboembolism, haemorrhage, pulmonary haemorrhage or haemoptysis, congestive heart failure, posterior reversible encephalopathy syndrome, hypersensitivity or infusion reactions, osteonecrosis of the jaw, ovarian failure and neutropenia. For full details of adverse reactions and contraindications, see the summary of product characteristics.
2.3 Bevacizumab is available in 100 mg and 400 mg vials at prices of £242.66 and £924.40 respectively (excluding VAT; 'British national formulary' [BNF] edition 64). The manufacturer estimated the cost of bevacizumab (excluding VAT and assuming wastage) to be £36,078 for a patient weighing 65 kg at a dosage of 15 mg/kg every 3 weeks, amounting to an average monthly cost of £2577. Costs may vary in different settings because of negotiated procurement discounts.