The use of bevacizumab among women with metastatic breast cancer: A survey on clinical practice and the ongoing controversy

Abstract

BACKGROUND:The US Food and Drug Administration's (FDA's) recent decision to remove the indication of bevacizumab for metastatic breast cancer (MBC) has fueled a debate in the breast cancer community. We conducted a survey to assess the perception of health care workers involved in the management of women with MBC on the FDA's decision to ascertain how it will affect practice and to determine how bevacizumab is commonly used in the community for MBC. METHODS: E-mails were sent out between September and November 2010 using a database of 3000 addresses maintained by the United Arab Emirates Cancer Congress. Individuals working for Roche or Genentech were excluded. The survey consisted of 22 questions that were divided into 3 parts addressing each participant's demographic profile, their opinion of the FDA's decision, and the typical use of bevacizumab in the community in the setting of MBC. RESULTS: A total of 564 participants were included in the final analysis, contributing to an 18.8% response rate. Of these participants, 14.6% were from the United States, 7.8% were from Canada, 31.1% were from Europe, 2.0% were from the United Arab Emirates, 11.1% were from Asia, and 33.3% were from other countries. The majority of participants believed progression-free survival to be a surrogate for overall survival, that cost played a role in the FDA's decision, and that the decision would adversely affect the future of newer drugs currently being investigated for MBC. The majority of participants indicated that they would use bevacizumab for triple receptornegative MBC (46.5%), would use it in a first-line setting (44.7%), and would use it in combination with paclitaxel (51.9%). CONCLUSION: Our survey results highlight the discord between the opinion of community oncologists and the FDA's recent decision to withdraw the indication of bevacizumab for MBC.

Weighed, Measured, and Still Searching: Bevacizumab in the Treatment of Unselected Patients with Advanced Breast Cancer

“…In contrast, the National Comprehensive Cancer Network recently ratified the use of bevacizumab in combination with paclitaxel, with 24 votes for and one abstention, and the European Medicines Agency maintained its approval (albeit qualified in combination with paclitaxel or capecitabine only) [8 -10]. A recent worldwide survey of 564 oncologists (14.6% from the U.S., 7.8% from Canada, and 31.1% from Europe) showed that 52% of physicians did not think it was justified to withdraw bevacizumab's approval based on a smaller PFS benefit in the AVADO and RIBBON-1 trials than in the ECOG 2100 trial, whereas 48% believed it was [11]. Following the FDA's decision, Blue Shield of California was the first large insurer to declare that it will stop coverage for bevacizumab for breast cancer patients [12].…”

Contraindicated Use of Bevacizumab and Toxicity in Elderly Patients With Cancer

“…Along the same lines, use was higher in patients with contraindications who had a diagnosis of colon cancer. However, in women with breast cancer, for whom the use of bevacizumab has been controversial, 30 and ultimately resulted in the reversal of FDA approval in 2011, the percentage of women who received bevacizumab increased from 3% in 2005 to 20% in 2007, with 54% receiving it with a contraindication and 25% of women having at least one complication after its use. Presumably, the use of bevacizumab in patients with breast cancer continued to rise between 2007 and 2011, given that the FDA did not grant approval until 2008.…”

Use of Bevacizumab as a First-Line Treatment for Metastatic Breast Cancer

“…The revocations started a debate that divided opinion in the oncologist community, as revealed in a worldwide survey in which 52% of responding oncologists disagreed with the fda decision 12 . The key point in the debate is whether the main therapeutic objective should be the same for all malignancies, or whether it should vary depending on the aggressiveness of the disease and the chance of receiving further treatments, which differs across settings.…”