Value of Bevacizumab in Ovarian Cancer Got a Boost in a New Analysis

October 2011, Vol 2, No 6

Stockholm, Sweden—The indefinite use of bevacizumab (Avastin) in patients with re lapsed ovarian cancer got another boost at the 2011 European Multi disciplinary Cancer Congress, with a subanalysis of the phase 3 OCEANS trial showing consistent benefit across subgroups. The main finding of OCEANS, which was reported earlier at the 2011 American Society of Clinical Oncolo - gy annual meeting, was that the addition of bevacizumab to carboplatin (Paraplatin)/gemcitabine (Gemzar) in patients with advanced ovarian cancer reduced the risk of disease progress - ion by 52%.

OCEANS enrolled 484 women with a first recurrence of ovarian cancer and no prior treatment with bevacizumab. In the experimental arm, bevacizumab 15 mg/kg was given concurrently with chemotherapy followed by bevacizumab maintenance until disease progression or unacceptable toxicity occurred. Patients in the control arm received chemotherapy plus placebo and placebo maintenance.

In Stockholm, OCEANS investigators reported a consistent effect across the majority of clinically relevant subgroups, including not only platinumsensitive patients and those with less bulky disease but also those with partially platinum-sensitive disease and bulky disease, who tend to fare poorly.

For patients with a platinum-free interval (PFI) of <24 months (indicating platinum sensitivity), median progression- free survival (PFS) was 16.6 months with bevacizumab and 11.6 months with placebo, for a 38% reduction in risk. For patients with a PFI of 12 to 24 months (indicating partial platinum sensitivity), median PFS was 12.3 and 8.6 months, respectively, for a 48% risk reduction. Patients with PFI <12 months, indicating less platinumsensitive disease, had a median PFS of 12.5 months and 7.4 months, respectively, for a 64% risk reduction, Dr Aghajanian reported. Overall survival data are not yet mature.

“Bevacizumab plus chemotherapy followed by bevacizumab until disease progression should be considered an option for recurrent ovarian cancer,” said Carol Aghajanian, MD, of Memorial Sloan-Kettering Cancer Center, New York.

Putting the results of OCEAN together with those of 2 other key trials— ICON7 and Gynecologic Oncology Group (GOG)-218—the study’s formal discussant, Stanley Kaye, MD, Royal Marsden Hospital and Institute for Cancer Research, London, commented on the status of vascular endothelial growth factor inhibition in ovarian cancer. “This is its finest hour,” he said. “It seems that patients with a relatively poor outlook have the most to gain. A key message is that in recurrent disease, bevacizumab should be given with chemotherapy and continued until disease progression.”

Quality of Life Not Worsened with Frontline Bevacizumab

Additional studies analyzed quality- of-life data in the ICON7 and GOG trials, showing that incorporating bevacizumab into frontline therapy of patients with ovarian cancer did not worsen, or improve, quality of life.

Although the studies had somewhat different designs and end points and used different doses of bevacizumab, together they provide “an unprecedented database on quality of life in ovarian cancer that will be valuable for future studies,” said Ate G. J. van der Zee, MD, of University Medical Center in Groningen, the Netherlands.

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