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Survey: Most Oncologists Prescribe Avastin (Bevacizumab) Off-label to Ovarian Cancer Patients

Clinicians face access and reimbursement hurdles (August 14)

Decision Resources, a research and advisory firm located in Burlington, Mass., finds that Avastin (bevacizumab, Roche/Genentech), although currently not FDA-approved for the treatment of ovarian cancer, is prescribed by approximately 70 percent of surveyed oncologists in first-line advanced ovarian cancer.

Avastin is most often prescribed in this setting as an add-on agent to doublet platinum-based chemotherapy followed by continued administration of Avastin as a maintenance monotherapy. Approximately half of the surveyed oncologists who prescribe Avastin in first-line advanced ovarian cancer indicate that they encounter reimbursement barriers, such as prior authorization, when prescribing Avastin for these patients.

The report also finds that current treatment of ovarian and endometrial cancers relies heavily on generically available chemotherapies and that carboplatin/paclitaxel is often prescribed in early-stage ovarian cancer, in first-line advanced ovarian cancer, and in early-stage and advanced endometrial cancer. However, the use of Avastin for the treatment of ovarian cancer in all disease settings is common among surveyed oncologists, and more than 65 percent of surveyed oncologists think that treatment rates with Avastin will increase in the next 5 years — primarily because they believe Avastin will gain regulatory approval for ovarian cancer.

Avastin is rarely used by the surveyed oncologists for the treatment of endometrial cancer; however, surveyed oncologists believe that angiogenesis inhibitors can play a role in its treatment, with 70 percent of surveyed oncologists responding that targeting the vascular endothelial growth factor (VEGF) pathway will likely be a promising treatment approach in this disease.

The report also finds that demonstrating a survival advantage over currently available therapies is of paramount importance to most surveyed pharmacy directors (PDs) at managed care organizations (MCOs) for formulary inclusion and favorable tier status for ovarian cancer therapies. Surveyed MCO PDs indicate that the cost of treatment has a smaller impact on these decisions.

“The high use of off-label Avastin in ovarian cancer means that novel therapies for ovarian cancer, such as Amgen/Takeda Pharmaceutical’s trebananib, Merck/Endocyte’s vintafolide, and GlaxoSmithKline’s Votrient (pazopanib), will not only face strong competition from generically available chemotherapies, but also from premium-priced Avastin,” said analyst Karen Pomeranz, PhD. “Strong efficacy data and competitive pricing of emerging therapies compared with Avastin will encourage a high proportion of surveyed MCO PDs to offer reimbursement to novel ovarian cancer therapies and physicians to incorporate these agents into the treatment algorithm.”

Source: Decision Resources; August 14, 2013.

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