We are very sorry to learn about anyone who has been diagnosed with cancer and we completely understand the devastating effect that it has on patients and families. We are grateful that you have taken the time to raise this important matter. The Government understands how important it is for patients to have access to the most effective cancer treatments. Please be assured that cancer prevention, public health and early diagnosis remain key priorities for this Government.

Avastin is available to NHS patients with some types of cancer through the Cancer Drugs Fund (CDF). The CDF provides funding for cancer medicines where the evidence is not strong enough to support routine NHS funding, including medicines used outside their marketing authorisations or “off-label” that are not assessed by the National Institute for Health and Care Excellence (NICE). Since it was established in October 2010, the CDF has helped many thousands of patients in England to benefit from life-extending cancer drugs that would not otherwise have been available to them. This year £340 million has been invested in the Fund and we have spent more than £1.9 billion helping people with cancer get the treatments they need.

Through the CDF, Avastin is available for the treatment of:
• first line treatment of recurrent or metastatic cervical cancer in combination with chemotherapy
• first line treatment of advanced epithelial ovarian, fallopian tube, or primary peritoneal cancer
• third line treatment of low-grade gliomas of childhood.
It is important that we have a system in place for making evidence-based decisions on whether new medicines should be routinely funded by the NHS, based on their clinical and cost effectiveness.

Through its technology appraisal programme, NICE makes evidence-based recommendations for the NHS on whether new medicines represent an effective use of resources and should be routinely funded by the NHS. Where NICE recommends a medicine, NHS commissioners are legally required to make routine funding available so that clinicians can offer it to their patients. Many thousands of patients, including patients with colorectal cancer, have benefitted from access to effective new medicines as a result of NICE’s important work.

NICE has published 12 technology appraisals (four of which were terminated due to the companies not providing evidence) involving the drug Avastin (which is also known as bevacizumab) for its use as a licensed medicine in the treatment of different cancers, including colon cancer.

NICE has only been able to recommend Avastin, in combination with the drug atezolizumab, as an effective use of NHS resources (at a price proposed by the manufacturer of Avastin, Roche) for metastic non-squamous non-small-cell lung cancer in adults. NICE understands that the decisions it makes have real and significant implications for patients and their families and only publishes a final decision on the use of a new medicine after a very careful consideration of the evidence and consultation with stakeholders, including patients.

However, NICE keeps its published guidance under review and has processes in place to update its recommendations if there is any change to the evidence base, including any relevant change in the price of the medicine. We understand that a number of patents for Avastin are due to expire over the next few years and other companies plan to place similar medicines to Avastin on to the market to treat the same conditions. These are called biosimilars. While the introduction of a biosimilar for a medicine such as Avastin would not automatically trigger an earlier consideration for review or an automatic decision to update the guidance, NICE is aware that biosimilars for Avastin are being prepared and is actively considering the impact of this on the existing guidance.

NICE has also been able to recommend other drugs for patients with colorectal cancer, such as:
• Lonsurf (trifluridine–tipiracil) for previously treated metastatic colorectal cancer
• Erbitux (cetuximab) and Vectibix (panitumumab) for previously untreated metastatic colorectal cancer

Department of Health and Social Care.