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