Avastin — If it doesn’t work (in breast cancer), why use it? A triumph of marketing over reasoning!

The FDA will decide shortly whether to continue Avastin’s metastatic breast cancer indication. The article in the Post puts it in terms of “freedom” to choose any treatment regardless of cost or efficacy. However when a drug doesn’t work for the indication, what’s the rationale for it’s use?

An FDA advisory committee voted 12 to 1 on July 20 to withdraw Avastin’s authorization for advanced breast cancer based on two new studies that the advisers concluded had not shown that the drug extends life. Not only that, the committee concluded that the studies indicated the drug slowed tumor growth for even less time — perhaps as little as about a month. “The vast majority opinion of the committee was that the drug was not doing very much, and what it was doing was more than offset by the negative,” said Wyndham Wilson of the National Cancer Institute, who chaired the committee. Avastin can cause a variety of potentially serious side effects, including blood clots, bleeding and heart failure. “In our best judgment, we did not feel this drug was safe to give relative to its benefits,”

And of course the republican response:

“I fear this is beginning of a slippery slope leading to more and more rationing under the government takeover of health care that is being forced on the American people,” said Sen. David Vitter (R-La.).

Medicynical Note: There may be some utility for Avastin in breast cancer but the studies show no survival benefit. Desperate cancer patients will try virtually any therapy that may offer a benefit, this is particularly the case where there is no or little financial participation in covering the costs. The irony in Senator Vitter’s “concern” is that his party’s solution to health care, the so called free market, formalizes economic rationing of care (if you don’t have the money you don’t get the care). Our non-system is bankrupting patients, insurers, and the country. We need some rationale, like efficacy, to decide which treatments to use and pay for. Of course individuals should be free to buy whatever therapy they wish whether it works or not–and considering the boon in the Mexican cancer hospitals along the border, they do.