The National Institute for Health and Clinical Excellence (NICE) has published new guidance on the use of bevacizumab, better known as Avastin, as a treatment for breast cancer that has spread.

It recommends that bevacizumab - when used in conjunction with chemotherapy drug capecitabine - should not be used as an initial treatment for breast cancer that has already spread, in people for whom other chemotherapy options are not considered appropriate.

They say this is because there is little evidence that the combination works better than existing, cheaper drugs.

The development of the final guidelines included a review of all available evidence as well as a public consultation.

It marks the sixth time NICE has assessed bevacizumab as a treatment for cancer, having previously looked at its use for advanced bowel cancer (in combination with oxaliplatin, cetuximab or other drugs), advanced breast cancer with taxane chemotherapy, lung cancer, and kidney cancer.

On each occasion it has not recommended that the drug be routinely used.

Peter Johnson, Cancer Research UK's chief clinician, pointed out that bevacizumab "is an expensive treatment", and there was little evidence that the benefits outweigh the risks of taking the drug for the majority of patients - a situation he described as "disappointing".

"Doctors can apply for their patients to receive the drug if they believe it will benefit them, through the cancer drugs fund in England, and through individual patient treatment requests in the rest of the UK," he added.

Sir Andrew Dillon, NICE's chief executive, said the organisation couldn't recommend a drug that hasn't been shown to work as well as, or better than, current treatments and costs much more.

"Evidence presented to the independent Appraisal Committee did not conclusively show that bevacizumab, in combination with capecitabine, could improve overall survival or improve a patient's quality of life more than current treatment. These uncertainties, combined with the high cost of bevacizumab, mean the drug simply isn't cost-effective."

He added that while he understood the news would be disappointing to people, especially those with breast cancer that has spread elsewhere in their body, NICE does recommend a range of treatments that the NHS can use to treat metastatic disease and these are outlined in its clinical guideline on the diagnosis and treatment of advanced breast cancer.

Source: CRUK