Doctors Split on Avastin for Breast Cancer, Survey Says

An international survey of cancer doctors shows many question U.S. health advisers' 2010 rejection of Roche's drug Avastin to treat advanced breast cancer.

The small survey, published in the journal Cancer, shows almost half of the respondents would continue to use the drug under certain circumstances regardless of the final decision from the Food and Drug Administration.

"The controversy surrounding the FDAs decision on possibly withdrawing bevacizumab (Avastin's generic name) from its indication for use among women with (metastatic breast cancer) was felt across the globe," said Dr. Shaheenah Dawood, the survey's lead author, in an e-mail to Reuters Health.

Once thought to slow advanced, or metastatic, breast cancer by almost six months, more recent studies show Avastin only slowed the disease by two to three months.

The new numbers coupled with side effects, including ulcers in the stomach and intestines and blood clots, led an independent panel to reaffirm the FDA's proposal in June.

FDA commissioner Margaret Hamburg has yet to finalize the decision, but some insurers have already decided to stop paying for the $8,000-a-month drug. Others, including the federal Centers for Medicare and Medicaid Services, announced they will continue to cover the drug regardless of the FDA's decision.

Avastin's use for lung, kidney and brain cancers hasn't been challenged.

Dawood, of Dubai Hospital in United Arab Emirates, and her colleagues sent the survey to about 3,000 cancer doctors. Only 564 responded, however, limiting how representative the new findings are.

More than four out of 10 doctors said they would continue to use the drug under certain circumstances even if the FDA rejected it, and eight percent said, "of course I will use it."
A fifth of the respondents said they would not use the drug at all, and nine percent said they would be reluctant to use it.

"In the ideal world, I would like the ability to prescribe Avastin for my patients," said Dr. Eric Winer, director of the Breast Oncology Center at the Dana-Farber Cancer Institute in Boston. "However, I don't think this is a huge travesty if it's not available."

Winer said he has cut back on using Avastin in his own center, but said he did it independently of the FDA's proposal.

"Like the panel we were paying attention to the data coming out from other clinical trials," Winer told Reuters Health.

Although the FDA does not consider cost in its decisions, 78 percent of respondents thought it did. Even more thought the FDA's decision might open the door to the evaluation of other drugs.

The survey was conducted through the United Arab Emirates Cancer Congress. Dawood received honoraria from Roche, Avastin's manufacturer, but she said it was not connected to the survey.