Barriers to the Access of Bevacizumab in Patients with Solid Tumors and the Potential Impact of Biosimilars: A Physician Survey

Abstract

Access to bevacizumab, an important component of oncology treatment regimens, may be limited. This survey of oncologists in the US (n = 150), Europe (n = 230), and emerging markets (EM: Brazil, Mexico, and Turkey; n = 130) examined use of and barriers to accessing bevacizumab as treatment of advanced solid tumors. We also assessed the likelihood that physicians would prescribe a bevacizumab biosimilar, if available. Bevacizumab was frequently used as early-line therapy in metastatic colorectal cancer, metastatic non-squamous non-small-cell lung cancer, and metastatic ovarian cancer (all markets), and as a second-line therapy in glioblastoma multiforme (US, EM). A greater percentage of EM-based physicians cited access-related issues as a barrier to prescribing bevacizumab versus US and EU physicians. Lack of reimbursement and high out-of-pocket costs were cited as predominant barriers to prescribing and common reasons for reducing the number of planned cycles. Overall, ~50% of physicians reported they "definitely" or "probably" would prescribe a bevacizumab biosimilar, if available. Efficacy and safety data in specific tumor types and lower cost were factors cited that would increase likelihood to prescribe a bevacizumab biosimilar. A lower cost bevacizumab biosimilar could address the unmet needs of patients and physicians worldwide, and may have the greatest impact on patient outcomes in EM.

Keywords: access to health care; bevacizumab; biosimilars; colorectal cancer; non–small-cell lung cancer; ovarian cancer.

Figure 1

Treatment guidelines followed by physicians, by primary tumor type ^a. ^A,B,C Letters indicate a significant difference between subgroups (p < 0.05): A = US; B = EU; C = EM. ^a Percentages are based on respondents who reported treating patients who had each primary tumor type. EU, European Union (United Kingdom (UK), Italy, Germany, and France); EM, emerging markets (Brazil, Mexico, and Turkey); mCRC, metastatic colorectal cancer; NCCN, National Comprehensive Cancer Network; ASCO, American Society of Clinical Oncology; mNSCLC, metastatic non-squamous non–small-cell lung cancer; mOC, metastatic ovarian cancer; mBC, metastatic breast cancer; GBM, glioblastoma.

Figure 2

Barriers to bevacizumab access, by primary tumor type ^a. ^A,B,C Letters indicate a significant difference between subgroups (p < 0.05): A = US; B = EU; C = EM. ^a Percentages are based on respondents who considered access to bevacizumab as difficult (a score ≤3 on a scale from 1 = not at all easy to 7 = very easy). ^b Small sample size; results interpreted with caution. ^c Answer option “not available in practice” indicates that physicians did not have the drug on hand. ^d Answer option “not recommended by guidelines/protocol” indicates there was no specific recommendation for bevacizumab use. EU, European Union (UK, Italy, Germany, and France); EM, emerging markets (Brazil, Mexico, and Turkey); mCRC, metastatic colorectal cancer; mNSCLC, metastatic non-squamous non–small-cell lung cancer; mOC, metastatic ovarian cancer; mBC, metastatic breast cancer; GBM, glioblastoma.

Figure 3

Reasons for reducing the number of planned bevacizumab cycles, by primary tumor type ^a. ^A,B,C Letters indicate a significant difference between subgroups (p < 0.05): A = US; B = EU; C = EM. ^a Values represent the percentages of respondents who reported “frequently” or “occasionally” (a score of 3 or 4 on a scale from 1 = never to 4 = frequently) having to reduce the number of planned bevacizumab cycles among those who reported treating each primary tumor type. ^b Small sample size; results interpreted with caution. ^c Answer option “not available in practice” indicates that physicians did not have the drug on hand. ^d Answer option “not recommended by guidelines/protocol” indicates there was no specific recommendation for bevacizumab use. EU, European Union (UK, Italy, Germany, and France); EM, emerging markets (Brazil, Mexico, and Turkey); mCRC, metastatic colorectal cancer; mNSCLC, metastatic non-squamous non–small-cell lung cancer; mOC, metastatic ovarian cancer; mBC, metastatic breast cancer; GBM, glioblastoma.

Figure 4

Likelihood a physician would prescribe a bevacizumab biosimilar, by primary tumor type ^a. ^A,B,C Letters indicate a significant difference between subgroups (p < 0.05): A = US; B = EU; C = EM. ^a Values represent the percentages of respondents who indicated they “definitely” or “probably” (a score of 4 or 5 on a scale from 1 = definitely would not prescribe to 5 = definitely would prescribe) would prescribe biosimilar bevacizumab among those who reported treating each primary tumor type. EU, European Union (UK, Italy, Germany, and France); EM, emerging markets (Brazil, Mexico, and Turkey); mCRC, metastatic colorectal cancer; mNSCLC, metastatic non-squamous non–small-cell lung cancer; mOC, metastatic ovarian cancer; mBC, metastatic breast cancer; GBM, glioblastoma.