The high cost of bevacizumab can impede access to this anticancer agent, particularly in emerging markets. A recent survey of physicians around the world found that a majority of them would be willing to prescribe a biosimilar if it became available, which could potentially lower costs and expand access.
Currently, there is no approved biosimilar for bevacizumab, a monoclonal antibody used to treat advanced solid tumors, including metastatic colorectal cancer (mCRC) and advanced or metastatic non-squamous non-small-cell lung cancer (mNSCLC). In the United States, it is approved for treating glioblastoma (GBM) and metastatic ovarian cancer (mOC), and in the European Union (EU) it is indicated for patients with metastatic breast cancer (mBC). Bevacizumab has been shown to prolong survival in patients with these cancers when combined with chemotherapy.
A survey of 510 oncologists in the United States, the EU, and emerging markets (Brazil, Mexico, and Turkey) has, however, revealed interesting disparities in rates of prescribing and perceptions of access, according to a study recently published in the journal Pharmaceuticals.
Of the surveyed physicians who did not frequently prescribe bevacizumab, those from emerging markets were more likely to cite access as a barrier to prescribing across all tumors types. Further, physicians in the United States and EU found it easier to access the drug when treating patients with mCRC, mNSCLC, and mOC than physicians in emerging markets. US physicians could readily access bevacizumab for treatment of GBM than physicians in the 2 other markets, while EU physicians found it easier to access the drug for mBC.
The predominant reasons for the perceived barriers to access were that the drug’s costs were “not reimbursed by healthcare system/private insurance,” and the “high out-of-pocket (OOP) costs to the patient.” These barriers were most commonly cited by physicians in emerging markets, although 67% of American respondents said lack of reimbursement was a barrier to prescribing the drug for mOC, compared with 55% of physicians in emerging markets and just 24% in the EU.
Roughly 50% of respondents agreed that reducing the amount of bevacizumab cycles would likely or very likely impact patient quality of life and survival, yet some found it necessary to do so. Of the physicians who had to reduce the number of cycles prescribed, the most common reason across all markets and tumor types was the lack of reimbursement. A significantly higher number of physicians in the US (40%) reported they had to reduce the number of cycles for GBM treatment because of high OOP costs to patients, compared with physicians in the EU (18%) and in emerging markets (19%).
Considering these cost-related barriers, it comes as no surprise that 42% to 92% of physicians across all tumor types and markets would definitely or probably prescribe a biosimilar for bevacizumab if it became available. Physicians in all regions cited efficacy and cost as the main reasons they would be willing to prescribe the biosimilar, although the most common rationales against biosimilar prescribing were concerns about efficacy and a lack of clinical trial data. The physicians who probably or definitely would not prescribe a biosimilar indicated that they might change their minds upon seeing more efficacy and safety data and substantial cost reductions compared to the originator.
“Overall, these data demonstrate that access-related issues create a barrier to bevacizumab use worldwide, but particularly among physicians in the EM [emerging markets],” the study authors concluded. “A bevacizumab biosimilar could offer the same opportunity to address the needs of patients with cancer by increasing access to bevacizumab, and generating cost savings that could be redistributed to expand patient access to other biologic therapies.”
Monk BJ, Lammers PE, Cartwright T, Jacobs I. Barriers to the access of bevacizumab in patients with solid tumors and the potential impact of biosimilars: a physician survey. Pharmaceuticals (Basel). 2017;10(1). pii: E19. doi: 10.3390/ph10010019.