Health News Review

Did the three studies on Avastin for ovarian cancer – published in the Dec. 29 issue of The New England Journal of Medicine show:

  • disappointing results?
  • tumor stabilizing results?
  • tumor slowing results?
  • the drug delays cancer progression?

Depends on which headline you read, and you clearly need to read beyond the headlines.

Different stories had different strong elements.

The Associated Press led with a “nut graf” – journalese for the main theme of the story – the news value – what it’s really all about.  AP’s headline:

Avastin disappoints against ovarian cancer

Opening paragraph: Avastin, the blockbuster drug that just lost approval for treating breast cancer, now looks disappointing against ovarian cancer, too. Two studies found it did not improve survival for most of these patients and kept their disease from worsening for only a few months, with more side effects.

The Los Angeles Times headline:

Avastin can stabilize tumors in ovarian cancer, studies find

Deep in the story: “Is it worth it?” said (an FDA advisory panel member on two of three panels that debated the use of Avastin for breast cancer) “These are positive studies, but are they meaningful differences?”

The Washington Post headline:

Avastin for ovarian cancer slows tumors but fails to prolong life

Body of the story: “in a disappointment for patients, neither study found that the expensive drug extends life expectancy.”

HealthDay labeled it:

Avastin May Help Some With Ovarian Cancer: Studies

Sub-head: Survival without disease getting worse rose slightly, but benefit on overall survival remains unclear

 Body of the story:

“I think the difficult reality is that these studies are not clear-cut,” said Dr. Len Lichtenfeld, deputy chief medical officer for the American Cancer Society. “The improvements in progression are modest and appear to be greater for women who have worse disease. What this ultimately means is that it’s absolutely important for doctors treating women with advanced ovarian cancer to read these studies very carefully so they know who may benefit and the risks of treatment, and to counsel their patients very carefully before moving forward with Avastin treatment,” Lichtenfeld explained.

“This is not a case where treatment can be initiated in every woman. The benefits for many women are modest at best,” he added.

Published reports peg the cost of the drug at somewhere between $4,000 and $9,000 a month, depending on co-pay assistance that’s available from Genentech, Avastin’s manufacturer. In a previous study, another research group looked at the cost effectiveness of treatment with Avastin in Burger’s trial and found the standard treatment arm of the trial cost $2.5 million. Treating the Avastin-initiation group cost $21.4 million and the Avastin-maintenance group cost $78.3 million, according to the study, which was published in the March 7 issue of the Journal of Clinical Oncology. And, most of those costs came directly from the cost of the medication. Those researchers concluded that Avastin was not a cost-effective medication.

“We don’t want cost to be a deciding factor, but for many women with ovarian cancer, cost may be a significant factor, and it needs to be weighed in the equation,” Lichtenfeld said.

WebMD‘s headline:

Avastin Delays Ovarian Cancer Progression

Sub-head: But Studies Don’t Show Clear Survival Advantage

Body of the story: The lack of a clear overall survival advantage means that ovarian cancer patients in the U.S. who take Avastin will continue to do so without the FDA’s approval for the foreseeable future, says an official with the Swiss pharmaceutical company Roche, which markets Avastin.

Roche media specialist Daniel Grotzky says the company is not likely to seek FDA approval for the drug’s use in ovarian cancer patients anytime soon.

“Following initial discussions with the FDA, we do not believe the data will currently support approval,” Grotzky tells WebMD. “We are still waiting for final overall survival data to make a final decision.

NBC’s network television story profiled a woman who “improved quickly” but emphasized that progression-free survival averages include some with sensational results and some who don’t respond at all.  But, as almost always happens, the only person profiled was one with sensational results – as the “tyranny of the anecdote” dominated the story’s message.

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MSNBC‘s online story headlined it:

Avastin slows advanced ovarian cancer’s progress, report says

The body of the story turned to one oncologist as the only expert source and that expert had a decidedly more positive outlook on the data than did some of those who were interviewed in other stories.

Excerpts:

“This is good news for women with ovarian cancer,” said that oncologist, who was not involved in the new study.

(She also said that the) three studies of the drug’s use in ovarian cancer showed a consistent benefit.

The safety of the drug as seen in the new study “was reassuring,” the oncologist said, as was the finding that patients taking the drug reported no difference in their quality of life from patients receiving the placebo.”

Comments

carl hammel posted on December 30, 2011 at 5:01 pm

Well, on the basis of this article, I have unsubscribed from my L.A. Times RSS health feed. Their reporting was the most disappointing of all of the above.

emc posted on January 4, 2012 at 10:54 am

It may be that the drug benefits women with a certain genetic profile, as yet undetermined. It’s frustrating to see drugs that may save lives abandoned, because we don’t know enough about genetic mutations. If some women got great results and others, mediocre, that suggests to me, a genetic component that is undiscovered. Of course, the drug company might not develop the drug if it only helps a small minority, because they can’t make enough money.

Annabelle South posted on January 5, 2012 at 9:01 am

Thanks for this interesting summary of the press coverage of the results of trials into Avastin for ovarian cancer. I think a lot of the press coverage has mis-read what the two (not three) studies published in the New England Journal on 29th December say with regard to whether it increases overall survival (life expectancy). The GOG218 trial did not find a difference in the life expectancy of women taking chemotherapy and bevacizumab versus those on chemotherapy alone. But the way that trial was carried out means that the investigators were unlikely to be able to detect any effect of bevacizumab on overall survival. This is because it is likely that many of the patients included in GOG218 will have received bevacizumab after disease progression. ICON7 does not have this problem as ICON7 was carried out in health economies where it is much less likely that patients will have been treated with bevacizumab after disease progression. But for the ICON7 trial, not enough time has passed to be able to tell accurately if bevacizumab does extend life expectancy for all the women who took part in it. These results will be available in 2013. From the data currently available, it looks as though bevacizumab may increase the life expectancy of women at high risk of disease progression by about eight months. So it is not yet clear if bevacizumab can extend the life expectancy of all women with ovarian cancer, but it looks very promising for those at highest risk.