Real World Safety and Effectiveness of Bevacizumab in Patients with metastatic Colorectal Cancer
The objective of this work is to examine real world outcomes of first-line bevacizumab (Avastin) for patients with metastatic colorectal cancer (mCRC) compared to a) pre-implementation projections and b) first-line chemotherapy irinotecan, fluorouracil, capecitabine and oxaliplatin. The following outcomes will be assessed:
1. Treatment utilization/budget impact
The purpose of this work is not to prove or disprove a specific hypothesis, but to assess whether bevacizumab performs as promised There have been at least 7 trials for this indication, with the earliest reporting a median overall survival (OS) of 21.5 months in the low dose arm (bevacizumab + fluorouracil[FU] + leucovorin[LV]), a 7.7 month gain over the control arm (FU + LV) (Kabbinavar et al, 2003). A more recent meta-analysis found a median OS of 18.7 months for bevacizumab with oxaliplatin or irinotecan chemo backbones, a 2.6 month gain over the control arm (oxaliplatin or irinotecan) (Hurwitz et al, 2013), which is considerably less than the expectations that drive current practice, policy and pricing.
Hurwitz, H., Tebbutt, N., Kabbinavar, F., Giantonio, B., Guan, Z., Mitchell, L., Waterkemp, D. * Tabernero, J. (2013). Efficacy and safety of bevacizumab in metastatic colorectal cancer: pooled analysis from seven randomized controlled trials. Oncologist, vol. 18(9), p. 1004-12.