Biosimilars unlock use of bevacizumab in bowel cancer by NHS

NICE has cleared the way for bevacizumab to be used by the NHS to treat colorectal cancer for the first time, thanks to the availability of lower-cost biosimilar versions of the drug.

In recently published draft guidance (PDF), the reimbursement authority recommends the use of the anti-CD20 antibody alongside chemotherapy for people with previously untreated metastatic colorectal cancer in England and Wales who would otherwise be offered chemo alone. It can also be used as a second-line option, according to NICE.

The new guidance brings England and Wales into line with the NHS in Scotland, which gave a green light to the use of bevacizumab for colorectal cancer in July – almost 20 years after it was approved for use in this indication.

Bevacizumab has been sold as Avastin by originator Roche for many years and used by the NHS for various forms of cancer, with lower-cost biosimilars now available from various competitors, including Zentiva (Alymsys), Organon (Abyntio), Celltrion (Vegzelma), and Pfizer (Zirabev).

Previously, NICE did not recommend the use of Avastin for colorectal cancer, arguing its price outweighed its benefits, but the availability of multiple biosimilars has dragged prices down and shifted the cost-effectiveness calculation.

Around 35,000 people are diagnosed with colorectal cancer in England each year. Nearly 10,000 of those will have metastatic colorectal cancer, according to the health technology assessment (HTA) agency, which estimates that bevacizumab will now become an option for more than 7,000 of them.

In clinical trials, adding bevacizumab to frontline fluoropyrimidine-based chemotherapy extended the time before cancer progresses from 8 to 9.4 months compared with chemo alone. Similarly, it increased overall survival to 21.3 months from 19.9 months.

At list prices, Avastin costs £242.66 for a 100 mg vial and £924.40 for a 400 mg vial, while the biosimilars range from £202.50 to £242.66 and £810.00 to £924.40, respectively. All the drugs will be offered to the NHS at an agreed, confidential discount.

"We're delighted that NICE has approved bevacizumab for first- and second-line treatment in combination with chemotherapy for advanced bowel cancer patients in England and Wales, following a similar announcement by the National Cancer Medicines Advisory Group for patients in Scotland," said the chief executive of patient advocacy group Bowel Cancer UK, Genevieve Edwards.

"This decision expands treatment options and could offer patients precious extra time with their loved ones," she added. "We're incredibly grateful to everyone who contributed to this appraisal by sharing their personal experiences. Their voices have been vital in helping to shape this welcome decision."