Public gets mixed messages regarding efficacy of Avastin for treating breast cancer

The Takeaway

On Friday, the FDA ruled that cancer drug Avastin should not be used to treat breast cancer because Avastin’s risky side-effects outweigh its benefits for breast cancer patients.

“Women who take Avastin for metastatic breast cancer risk potentially life threatening or serious side-effects, such as heart attacks or heart failure, severe high blood pressure, bleeding or hemorrhaging,” FDA Commissioner Dr. Margaret Hamburg said. 

Avastin still has FDA approval for treating lung, kidney, and colon cancer, and despite the ruling, Medicare will still cover Avastin for breast cancer patients. Private insurance companies can still choose whether to pay for doctors who use it to treat breast cancer as well.

Joe Nocera, an op-ed columnist for The New York Times, said this mixed message is enough to raise some eyebrows. With healthcare costs rising and broad agreement on the need for Medicare reform, no one’s willing to even use this FDA warning to stop paying for a treatment, the efficacy of which is seriously in doubt.

“Here you have a drug that costs $90,000 a year. For the vast majority of women, it does not work. For some of them, it has serious side effects,” Nocera said. “The FDA has ruled it can’t be marketed as a breast cancer drug, yet no one has the nerve to say we can’t pay for it.”

But many patients say Avastin is helping them, and that withdrawing it from the market would be a death sentence.

Nocera said the problem is there is a tiny segment of patients for whom Avastin is a big improvement, but to date, there is no means of identifying who those patients will be. The drug manufacturer says it can determine the qualities of those patients but has thus far been unable to accomplish just that.

“In medicine in general, there are a lot of drugs like this that help a tiny segment but are so unhelpful or even harmful to others that the costs outweigh the benefits,” Nocera said.

The problem becomes that no one wants to say we won’t pay for a drug, despite it only helping a tiny sliver of the population — and a sliver we can’t even identify, he added.

But according to Nocera, Medicare and private insurance really can’t stop offering the treatment, even if they were so inclined.

Nocera said Blue Shield of California actually did announce that it would stop offering Avastin to treat breast cancer. That announcement came down on a Friday and after a weekend of complaints, threats and calls from Congressmen, the company backed down on Monday.

“The reputational risk for these companies is just too high. They’d rather pay,” Nocera said.

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