NICE has gone ahead and cleared the way for bevacizumab to be used by NHS in order to treat colorectal cancer for the very first time, all thanks to the availability when it comes to the lower-cost biosimilar versions of the drug.
In a recently published draft guidance, the reimbursement authority has gone on to recommend the usage of the anti-CD20 antibody apart from chemotherapy for those suffering from the previously untreated metastatic colorectal cancer across England and Wales who might otherwise be offered only chemo. Notably, it can also get used as a second-line option, as per NICE.
It is well to be noted that this new guidance brings England as well as Wales in sync with the NHS in Scotland, which went on to give a green light to the usage of bevacizumab for colorectal cancer in July 2025, and that too around 20 years after it got approved for use in this indication.
Interestingly, bevacizumab has been sold as Avastin by Roche for many years and was made use of by the NHS for numerous forms of cancer, with lower-cost biosimilars now being available from many competitors such as Zentiva-Alymsys, Organon-Abyntio, Celltrion-Vegzelma, and Pfizer-Zirabev.
In the past, NICE did not give its recommendation for the use of Avastin for colorectal cancer, arguing that its price outweighed its advantages; however, the availability when it comes to multiple biosimilars has indeed dragged the prices down and also shifted the cost-effectiveness calculation.
It is worth noting that almost 35,000 people are diagnosed with colorectal cancer across England every year. Around 10,000 of those go on to have metastatic colorectal cancer, as per the health technology assessment – HTA agency, which goes on to estimate that bevacizumab is now going to become an alternative for over 7,000 of them.
When it comes to clinical trials, adding bevacizumab to the frontline fluoropyrimidine-based chemotherapy went on to extend the time before cancer grows from 8 to 9.4 months as compared to chemo alone. Similarly, it also increased overall survival to 21.3 months from the previous 19.9 months.
In terms of list prices, Avastin costs £242.66 when it comes to a 100 mg vial and £924.40 in the case of a 400 mg vial, whereas the biosimilars range from £202.50 to £242.66 and £810.00 to £924.40, respectively. All the drugs are going to be offered to the NHS at a mutually agreed and confidential discount.
As per Genevieve Edwards, the chief executive of the patient advocacy group at Bowel Cancer UK, they are indeed delighted that NICE has gone on to approve bevacizumab for first as well as second-line treatment in mix with chemotherapy as far as advanced bowel cancer patients in England and Wales are concerned, posting a similar announcement to that made by the National Cancer Medicines Advisory Group for patients in Scotland.
With bevacizumab to be used by NHS, he further adds that this decision goes on to broaden the treatment alternatives and could as well offer patients some precious extra time with their loved ones. He further said that they are incredibly grateful to one and all who went on to contribute towards this appraisal through sharing their personal experiences. Their voices have indeed been vital when it comes to helping to shape such a welcome decision.
