Use of bevacizumab as a first-line therapy for ovarian cancer has doubled from 4.1% in 2008 to 8.2% in 2014, according to preliminary, non–peer-reviewed findings. Nonclinical factors driving uptake of the high-cost therapy include area of residence and clinician specialty, according to findings presented at the 50th Society of Gynecologic Oncology Annual Meeting in March 2019.1 The steepest shift upward occurred following addition of this indication to the National Comprehensive Cancer Network (NCCN) guidelines, which moved the needle more than did fresh findings from clinical trials.

“I’m not surprised to see more use after the guidelines inclusions,” said David O’Malley, MD, of the James Cancer Hospital and Solove Research Institute at The Ohio State University Comprehensive Cancer Center, Columbus, who was not involved in the work. This effect of the guidelines most likely reflects the reimbursement environment, he said. “A phase 3 trial didn’t move the bar, but guidelines did, because that along with approvals is very important to the clinician in practical terms for reimbursement.”

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Study authors Soledad Jorge, MD, and Kemi M. Doll, MD, both with the department of obstetrics and gynecology, University of Washington Medical Center, Seattle, have costs on their minds, as well. “We think it’s important for clinicians to appreciate the high costs of Bev and use it judiciously for those most likely to benefit,” Drs Doll and Jorge said in an email to Cancer Therapy Advisor

Using data from the Truven Health MarketScan® cache covering 2007 to 2014, Drs Doll and Jorge assessed how many women aged 18 to 65 years with a new diagnosis of ovarian cancer received bevacizumab treatment within 6 months.

In addition to finding a more than doubling of first-line use of bevacizumab in this patient population from 2008 to 2014, the investigators identified nonclinical factors that were associated with this therapeutic option. These factors included living in the north-central or southern United States (odds ratios [ORs] 1.36 and 1.53, respectively) and receiving treatment from a medical oncologist rather than a gynecologic oncologist (OR, 1.83).

On the clinical side, having diagnosis codes for metastatic disease (OR, 5.06) or ascites (OR, 1.36) also was linked to greater odds of initiating bevacizumab. Patients receiving intraperitoneal chemotherapy had reduced odds of starting bevacizumab within 6 months of their ovarian cancer diagnosis (OR, 0.46).

Drs Doll and Jorge found that the costs of bevacizumab were “high and variable.” The median cost of $6896 came in at more than twice the Medicare reimbursement, which they said was estimated at $3225 per cycle of maintenance bevacizumab at 7.5 mg/kg.

Use of bevacizumab plateaued during 2 periods, the investigators reported, from 2012 to 2014 and from 2014 to 2016. The upward slopes coincided with efficacy findings from clinical trials in 2007, climbing even more steeply with the addition of bevacizumab to the NCCN guidelines in 2012. 

In 2018, the U.S. Food and Drug Administration (FDA) approved bevacizumab as a first-line treatment for ovarian cancer.2 The data for this study preceded the FDA approval, and Drs Doll and Jorge expect that use rates likely have increased even more since then. “With FDA approval, obtaining insurance coverage for treatment generally becomes easier, which helps drive use,” they said. 

O’Malley concurred with that prediction. With the FDA approval, he said, “you will see another big jump.” These associations, he added, point to a need for more prompt guidelines updates and approvals to aid in validating reimbursements and facilitating patient access to treatments.

References

  1. Jorge S, Gray HJ, Goff BA, and Doll KM. Impact of research findings and NCCN guidelines on use of bevacizumab for newly diagnosed ovarian cancer in the United States. Presented at: The Society of Gynecologic Oncology (SGO)’s 50th Annual Meeting on Women’s Cancer; Honolulu, Hawaii; March 16-19, 2019. Abstract 2316.
  2. US Food and Drug Administration. FDA approves bevacizumab in combination with chemotherapy for ovarian cancer. Updated June 13, 2018. Accessed May 20, 2019.