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 gemcitabine has a marketing authorisation for 'treatment of adult patients with first recurrence of platinum-sensitive epithelial ovarian, fallopian tube or primary peritoneal cancer who have not received prior therapy with bevacizumab or other VEGF inhibitors or VEGF receptor-targeted agents'. The licensed dose of bevacizumab is 15 mg/kg of body weight given once every 3 weeks in combination with carboplatin and gemcitabine for 6 cycles and up to 10 cycles, followed by continued use of bevacizumab as single agent until disease progression.
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 net prices of £242.66 and £924.40 respectively (excluding VAT; 'British national formulary' edition 65). The manufacturer estimated the cost of a course of treatment with bevacizumab (excluding VAT and assuming vials are not shared between patients) to be £25,208 for a patient weighing 60.5 kg at a dosage of 15 mg/kg every 3 weeks for a mean treatment duration of 10.8 cycles (7.5 months). Costs may vary in different settings because of negotiated procurement discounts.