For many with advanced lung, colon, or breast cancer, bevacizumab—also known as Avastin—is prescribed as a last beacon of hope in often hopeless situations. Avastin is made by Genentech and considered by many to be a wonder drug because of its ability to cut off a tumor’s blood supply. The drug does not come cheap and can run around $100,000 annually. Despite this, Avastin has become one of the most popular cancer drugs in the world.
But the drug is not without controversy and studies show Avastin only prolongs life by a few months, if that. Newer studies suggest the drug might be less effective against cancer than the Food and Drug Administration (FDA) had understood when it first approved Avastin. While many patients and their doctors say the drug can improve the quality of life by providing intangibles such as a sense of well-being and an ability to carry out daily tasks without exhaustion or pain, these benefits are difficult to monitor and document. And, now, many patients with other cancers are taking Avastin, despite that there is no compelling evidence that helps. Avastin also has serious, sometimes lethal side effects.
Avastin is generally used in conjunction with standard chemotherapy and does not work as well when used alone, meaning that patients are still subject to chemotherapy’s side effects. “I still use Avastin routinely, but it’s sobering,” Dr. Leonard Saltz, a colon cancer specialist at Memorial Sloan-Kettering Cancer Center in New York, said of the new data. “It’s not a slam dunk and, in fact, the incremental benefit may be more modest than we want to admit.”
Roy Vagelos, a former chief executive of Merck said that he was troubled by a drug—which he would not name, but was clearly Avastin—that costs $50,000 a year and adds four months of life. “There is a shocking disparity between value and price,” he said, “and it’s not sustainable.” Some patient advocates are also concerned by prohibitively expensive treatments like Avastin that don’t provide a lot of bang for the buck. “It’s absolutely critical that we start having a public discussion,” said Barbara Brenner, executive director of Breast Cancer Action, an advocacy group.
About 100,000 Americans take Avastin, according to Genentech’s data and new studies are underway that will include over 26,000 people with lung, colon, or breast cancer at earlier stages of the disease than were studied initially. If Avastin is approved for earlier-stage groups, it could provide delays in cancer returns; however, with hundreds of thousands of additional people taking it, possibly for years, there is the potential for a considerable financial burden.
The drug’s price, charged by Genentech, can be $4,000 to over $9,000 monthly, depending on patient weight and cancer type. Avastin’s cost to patients and insurers can be higher because doctors and hospitals buy Avastin and then sell it to patients or their insurers, often marking up the price, which means the $2.3 billion that Genentech recorded in Avastin sales represents a portion of what Americans really spent on Avastin in 2007.
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