Real World Safety and Effectiveness of Bevacizumab in Patients with metastatic Colorectal Cancer

Project number: 
Approval date: 
Friday, September 22, 2017
Principal Investigator: 
BC Cancer
Funding Agency: 
Not Available
Datasets requested: 
Home and Community Care (BC Ministry of Health)
ACG Case Mix Group (Johns Hopkins University)
bc cancer-external
PharmaCare (BC Ministry of Health)
Deaths (BC Vital Statistics Agency)
consolidation - census geocodes
Hospital Separations (BC Ministry of Health)
Consolidation registry (Ministry of Health)
bc cancer
Medical Services Plan (BC Ministry of Health)
Research objective: 

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
2. Effectiveness
3. Safety
4. Cost-effectiveness

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.

Page last revised: September 2, 2019