The drug Avastin helps women with advanced cervical cancer live nearly four months longer, according to a new study that's predicted to change the standard of care for the disease.
Women who combined Avastin and chemotherapy lived a median of 17 months after diagnosis, while those who received chemo alone lived 13.3 months, according to a study of 452 women in the New England Journal of Medicine. Just two decades ago, women with advanced cervical cancer lived only eight or nine months, says lead author Krishnansu Tewari, a professor of gynecologic oncology at the University of California Irvine Medical Center.
Giving patients more time is especially important, given that women in the study were relatively young, in their 40s and 50s, Tewari says.
Although Avastin increased the risks of some serious side effects, including high blood pressure and blood clots, Tewari says women mostly had a good quality of life. About 3% of women on Avastin developed a serious complication called a gastrointestinal fistula, an abnormal opening in the stomach or intestines, which can allow contents to leak out, leading to serious or life-threatening infections. None of the women taking chemo alone developed fistulas, the study says.
Cervical cancer is mostly preventable, thanks to screenings that allow doctors to find and remove precancerous lesions, Tewari says. Doctors often can successfully remove early cervical cancers with surgery, as well. New vaccines against HPV, or human papilloma virus, also can prevent 70% of cervical cancers.
Still, 12,000 American women are diagnosed with the disease each year, and about 4,000 die from it, according to the American Cancer Society. Worldwide, 500,000 women are diagnosed each year and 250,000 die, Tewari says. Most women who died from the illness are low-income and haven't had access to health care in years, says Tewari, who presented an earlier form of his study at a meeting of the American Society of Clinical Oncology.
Paul Haluska, an associate professor of oncology at the Mayo Clinic in Minnesota, says adding Avastin to chemotherapy will become the new standard of care for advanced cervical cancer.
In response to his results, the National Comprehensive Cancer Network updated its practice guidelines to include Avastin for advanced cervical cancer. That has allowed many private insurers to cover the drug.
Genentech, which makes Avastin, plans to apply for approval for its use in cervical cancer from the Food and Drug Administration this year, spokeswoman Krysta Pellegrino says. Avastin is already approved in colon cancer and other tumors. FDA approval would allow patients on Medicare to receive Avastin, as well, Tewari says.
With a wholesale price of about $10,000 a month, it would cost about $82,000 to treat a patient with advanced cervical cancer, Pellegrino says. Genentech limits the annual cost of Avastin to $65,000 in patients "who need more Avastin because it is working well," Pellegrino says.
"None of us can put a price on a woman's life," Tewari says.
But Haluska notes that most cervical cancer deaths occur in developing countries where women aren't regularly screened.
"If we can't even pay for Pap smears" for poor women, he asks, "how are we going to get this very expensive medicine to these patients?"