Avastin and hope

One of my daughters once asked me about Avastin while we were standing in line (we’re a wonky family). I talked about progression-free survival for metastatic breast cancer, giving an overview similar to Dr. Tucker’s recent NYT Op-Ed. Then a person in front of us turned around, looking angry or hurt, saying they had a relative on Avastin. They wanted me to keep quiet. Talking about the clinical trial evidence was obviously painful to them. I apologized for talking too loudly and unintentionally hurting their feelings. People fighting for hope and recovery don’t want to hear a stranger talking about statistics. I understand that.

Emotion runs high with Avastin. Take a look at a pro-Avastin fight song from YouTube (h/t to Pharmalot), supposedly produced without any Genentech money. I kept expecting it to morph into sarcasm (see The Onion), but it never did. Seems like a genuine person who really thinks the FDA wants to crush a good drug.  [see the comment from Terry below]

Pharmalot was also the the first second to report* that the FDA won’t require Genentech’s experts to disclose their financial conflicts of interest when they testify at the upcoming hearing. Everyone’s financial conflicts of interest will be public and transparent, except the Genentech experts. Words. Fail. Me.

Anecdotes have their place absent clinical data, but when we have good studies, they should be given appropriate weight. Patients (and their families) will always hope they are the exception, at the far end of the bell curve. As perhaps they should. But  hope alone (even hope based on unknown genetic variants) should not be sufficient to drive $90,000/year reimbursement decisions if the clinical evidence is clearly opposed.

If we can’t get this right on Avastin, then I fear for our ability to bend the cost curve in IPAB.

Previous TIE Avastin coverage here.

UPDATE:  FiercePharma seems to have published a few minutes before Pharmalot.

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