Medicare to Continue to Cover Avastin Regardless of What FDA Decides

June 30, 2011 — -- Medicare will continue to cover Avastin for breast cancer treatment even if U.S. Food and Drug Administration Commissioner Peggy Hamburg decides to withdraw Avastin for such use, according to Don McLeod, a spokesman for the Centers for Medicare and Medicaid.

"The FDA decision, when it comes, does not affect CMS," McLeod told Reuters.

An FDA advisory committee recommended unanimously that Avastin no longer be used to treat breast cancer, saying that the risks of the drug far outweighed any benefits.

Avastin is currently used to treat other types of cancer in the U.S., including advanced colorectal, lung, kidney and brain cancers. The recommendation made by the advisory panel only affected its use for advanced stage breast cancer.

The drug will remain "on label" for breast cancer until Hamburg makes a final decision. Regardless, McLeod said, CMS will continue to cover Avastin for breast cancer.

"The drug will still be on the market, doctors will still be prescribing it, and we will continue to pay for it," McLeod told Reuters.

The FDA's recommendation came at the end of a two-day hearing that pitted the agency's Center for Drug Evaluation and Research against Genentech, Avastin's manufacturer.

"Even though we have anecdotal information, we don't have evidence that it prolongs survival or improves quality of life," said Natalie Compagni-Portis, a patient representative and voting member of the FDA panel. In a series of four questions, the six-member panel voted across the board that the clinical trials conducted by Genentech did not provide evidence that Avastin prolonged life for breast cancer patients, nor did it improve their quality of life. The panel also recommended that FDA commissioner Peggy Hamburg should not continue to allow the drug to be used for breast cancer patients.

Following the vote, some, presumed to be breast cancer patients and their families, interrupted the hearing as they expressed their disappointment at the panel's decision.

Although a handful of patients testified Tuesday that Avastin helped in treating their metastatic breast cancer, a review of studies conducted by the FDA's Center for Drug Evaluation and Research convinced the panel that Avastin should no longer continue to be marketed as a treatment for advanced breast cancer.

Priscilla Howard, who has metastatic breast cancer, has been taking Avastin for a little more than two years and has seen a remarkable difference in the progression of her disease, she told a panel of experts at the U.S. Food and Drug Administration during the first day of the two-day hearing.

"I am progression free but not cancer free," said Howard, one of a handful of Avastin patients who gathered both inside and outside the FDA to fight for keeping Avastin on the market.

"I want every available weapon in my arsenal as I fight this devastating disease," Howard told the panel. The hearing will ultimately decide the fate of what some patients consider a lifesaving drug.

The FDA granted an accelerated conditional approval for Avastin in February 2008 to treat late-stage breast cancer patients. It had been suggested that the drug slowed the progression of the disease and improved overall survival. But results from four trials that enrolled more than 3,000 women found no significant reduction in progression of the disease or improvement of death rates among those who took Avastin and underwent chemotherapy.

"The decision must be based on the totality of evidence in all clinical trials," Dr. Richard Pazdur, director of the FDA's Office of Oncology Drug Products, said at the hearing Tuesday. "The totality of data submitted to FDA shows it's not safe and effective [for treating] breast cancer."

Experts who defended Genentech at the hearing suggested that Avastin coupled with the chemotherapy paclitaxel showed benefit for many patients. The manufacturers proposed conducting a new study to prove Avastin's efficacy.

"We are very disappointed by the committee's recommendation and hope the Commissioner does not decide to remove an important medicine for women with this incurable disease who already have too few treatment options," Genentech wrote in response to the vote. "We remain ready to collaborate with the FDA to find a solution that is in the best interest of patients who need Avastin."