Submitted by Dr.Kattlove’s Cancer Blog

The FDA advisory committee has recommended against Avastin for use in women with advanced breast cancer. Are they depriving these women of a life prolonging treatment? The simple answer to this question is no.

Avastin is a drug that treats cancer by blocking the blood supply to the cancer. This way, the cancer starves to death because it is deprived of nourishment from the blood. For many years, scientists have known that one of the main steps in a cancers growth was the formation of new blood vessels to supply it with nutrients. Avastin, also known as bevacizumab, prevents this new blood vessel growth.

Researchers have been attracted by the concept of treating cancer with blood vessel-blocking agents. It makes sense. Starve the tumor. But, in practice this hasn’t worked that well. The drug has had a little success in treating widespread colorectal cancer and lung cancer but only when combined with chemotherapy.

It also seems to slow the progression of widespread breast cancer – also combined with chemotherapy. That is why it was brought up for FDA approval. The FDA advisory committee was bothered by the fact that the drug didn’t prolong the lives of the women, it cost a lot ($100,000/year), and it caused a lot of toxicity (holes in the intestines, bleeding into the lungs).

And there is another issue that was mentioned. We already have a lot of drugs that are effective in treating breast cancer. My own experience was that there was always another drug to treat patients with widespread breast cancer after the last one failed.

The problem is that after a woman has been through treatment with several different drugs, her cancer usually doesn’t respond to anything anymore. And also, she is generally not strong enough for another round of chemotherapy. So having a drug like Avastin, which would be the most toxic and expensive of all drugs used for breast cancer, would not help much.

We don’t need another drug that helps a little. We have lots of those. We need one that can hit a home run.

I think the FDA is becoming suspicious of all these drugs with only marginal benefit after being burned by the overuse of erythropoietin – a very expensive drug that stimulates blood production. After that drug was approved, the manufacturer, Amgen, marketed it like it was running for president. And so oncologists, like everyone else, susceptible to marketing messages, and seeing a profit in providing the drug, gave it to everyone. The bill for cancer care went up, but patients weren’t helped much. In fact, people may have been hurt – see my other blogs (5/10, 8/4) on the subject. Now the government, through Medicare, and private insurers, are limiting the use of the drug.

Perhaps the FDA advisers saw this as a potential problem with Avastin. Its manufacturer, Genentech, would market it to everyone, including patients. It would be given to lots of women with widespread breast cancer, and the cost of medical care would inch up.

So congratulations to the FDA advisory committee for a wise decision. To the women with widespread breast cancer, you will not lose by this. Indeed, you will gain less toxicity and get to keep some of your hard-earned dollars.

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