New bowel cancer drugs – fact behind the hype

Expert Comment on Daily Mail Bowel Cancer Story

The entire front cover of the Daily Mail yesterday was devoted to a pharmaceutical company product – Avastin: “Bowel cancer victims denied life-prolonging treatment that’s free in Europe.”

We therefore asked the top London teaching hospital Bowel Surgeon Austin Obichere what was going on here:

“Denying NHS patients the proven benefits of Avastin is arguably morally wrong, but this must not overshadow the potential life threatening side-effects of these drugs”.

Clinical trials demonstrate the benefit of drugs like Avastin and other monoclonal antibody agents in some patients with advanced colorectal cancer, and arguably, it is morally wrong to deny NHS patients this life-prolonging drug. However, there is ongoing debate between clinicians on the one hand and Health Economists on the other, whether the drug’s advantages, translated as prolonging one’s life by an average of 5 months and maintaining disease remission or control, justify the cost of treatment.

Avastin is known to work by cutting off the blood supply to the tumour cells, starving them of oxygen and nutrients which may result in cancer shrinkage and surgical removal in some cases. Unfortunately, not all patients respond to treatment and at best, only half of them receiving Avastin will derive any measurably benefit. Furthermore, this agent can cause an increase in blood pressure, blood clots in arteries / veins, and serious surgical complications such as intestinal perforation and impaired wound healing. Timing of an operation is therefore critical in order to avoid or minimise these side-effects and improve the outcome in patients requiring surgery.