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08
Feb
2019

Read Cure Brain Cancer Foundation's Avastin submission


Download a PDF of our full submission to the PBAC regarding Avastin.

Click here to submit your Avastin submission to the PBAC. 

Declaration of interest: Cure Brain Cancer Foundation is making this submission as we have a principle purpose to help better manage brain cancer. Cure Brain Cancer Foundation has a strong patient focus and is Australia’s leading organisation for brain cancer research, advocacy and awareness. We work with governments at all levels, engaging on the issues that concern the lives of people with brain cancer, their families and carers, and the community.

Consumer input: Cure Brain Cancer Foundation is writing to support the inclusion of the medication bevacizumab (marketing name Avastin®) to the Pharmaceutical Benefits Scheme (PBS). As the leading body for people with brain cancer, we are duty-bound to advocate on behalf of Australians with brain cancer and the wider brain cancer community. While our primary mission is to increase brain cancer survival from 20% to 50% by 2023, we are passionate about the provision of more affordable, equitable and accessible treatments that can improve the lives of people living with this insidious disease.

Each year, more than 1900 people will be diagnosed with brain cancer in Australia, and more than 1450 will die as a result of these tumours (AIHW, 2017)1Numbers continue to grow each year. Brain cancer kills more Australian children than any other disease and more young people under 40 than any other cancer. Survival rates have barely improved in more than 30 years, and neither have treatment options. 

While just 22% of brain cancer patients survive more than five years (AIHW, 2017), the figure for the most common and deadly form of brain cancer – glioblastoma (GBM) - is far worse. Just 4.6% of Australians diagnosed with this aggressive form of brain cancer will survive past five years (AIHW, 2017) and current treatments are largely ineffective, carry significant side-effects, and often diminish the patient’s quality of life. GBM is also extremely likely to recur, in which instance it is almost always fatal and treatment options are even more limited and less effective. 

The challenges faced by Australians with GBM are incomprehensible, resulting in a devastating financial and emotional impact on patients, their families, carers, and the community more broadly.

People with GBM, are almost always unable to retain employment for any length of time post diagnosis. The disease itself, surgery, and standard of care treatments, like chemotherapy and radiation, often leave patients with significant deficits and the inability to maintain employment. The economic impact of this is further confounded as partners and family members are often forced to leave employment to care for their loved ones fulltime.

Brain cancer’s high mortality rate, particularly among younger Australians, means each incidence of brain cancer in Australia costs the economy roughly $3 million per year. A 2008-2009 study estimated the annual cost of brain cancer to the Australian health system alone was $127 million (AIHW, 2017), accounting for 15% of total health system costs incurred by those diagnosed with cancer under the age of 40. That is higher than other common forms of cancer, like breast, lung and prostate cancer. 

Brain cancer’s high mortality rate and high burden of disease result in the highest per person lost productivity cost of any cancer, hence the health and economic necessity to provide patients with more affordable and accessible treatments, such as bevacizumab, which has been shown to increase progression-free survival (the length of time a patient lives with the disease following treatment, without it getting worse), and improve the lives of people living with this insidious disease. 

Bevacizumab is a tumour-starving drug that may prevent blood vessels from reaching tumours, potentially halting their growth. Bevacizumab is often presented as an option for patients with relapsed or refractory GBM in the final stages of disease. In this instance, it’s administered at two doses per month. Unfortunately, at between $3,600 to $4,600 per dose (depending on the patient’s weight) it’s out of reach for many Australians. Anecdotal evidence from the 2017 Senate Select Committee into Funding for Research into Low Survival Cancers also suggests that medical professionals find themselves making judgement calls about whether to mention expensive treatments like bevacizumab to patients they know may not be able to afford it.

As with all brain cancer medications, the efficacy, side-effect profiles and tolerability of a drug can vary greatly between individuals, and it is for this reason that a range of affordable treatment options is necessary to increase the chance of every individual finding an effective and well-tolerated treatment that suits their individual circumstances.

Bevacizumab is not without significant side effects and has not always produced positive outcomes for those able to afford it. Nor has it been shown to improve overall survival.2 However, research has demonstrated that bevacizumab does aid progression-free survival and anecdotal evidence from the brain cancer community, both in Australia and overseas, strongly suggests it can improve quality of life in the final stages for some. 

Overall, Cure Brain Cancer Foundation believes bevacizumab provides another viable treatment option that will help to reduce the health and financial burden for many Australians with recurrent GBM. Its potential effectiveness at improving progression-free survival could allow people with recurrent GBM to maintain parts of their lifestyle for longer, such as employment, physical activity and exercise, and give them more quality time with their loved ones. 

Together, these elements give a person with brain cancer purpose, focus, independence, drive and ultimately a potentially higher quality of life, improving progression-free survival, and helping alleviate some of the more debilitating symptoms of the disease. 

Having already been assessed for efficacy and safety by the Therapeutic Goods Administration, and approved for use in recurrent GBM by the US Food and Drug Administration (FDA), it is the belief of Cure Brain Cancer Foundation that this medication will make a valuable addition to the repertoire of medications available to people with recurrent GBM, and their oncologists.

It will allow for an appropriate treatment choice to be made according to the efficacy and possible side-effects in relation to an individual’s circumstances and will help to alleviate the economic cost of recurrent GBM to individuals, their families and the broader community. It will also give Australians with brain cancer equitable access to a treatment already offered overseas.

We appreciate you considering this treatment for listing on the PBS.

Click here to submit your Avastin submission to the PBAC.

Download a PDF our full submission to the PBAC regarding Avastin.

  1.        Australian Institute of Health and Welfare 2017. Brain and other central nervous system cancers. Cat. no. CAN 106. Canberra: AIHW.
  2.      Mehta, M. et al. A randomised trial of bevacizumab for newly diagnosed glioblastoma. N England J Med (2014): 370(8): 699-708

 

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