Bevacizumab in newly diagnosed ovarian cancer - The Lancet Oncology + references

Comment - open access

Several studies have assessed the activity of bevacizumab when added to chemotherapy in ovarian cancer. In Europe, bevacizumab is approved by the European Medicines Agency in combination with carboplatin and paclitaxel in newly diagnosed ovarian cancer, with carboplatin and gemcitabine in platinum-sensitive relapse ovarian cancer, and with chemotherapy in platinum-resistant relapse ovarian cancer. In the USA, bevacizumab is approved by the Food and Drug Administration when combined with chemotherapy for platinum-resistant relapse ovarian cancer. These approvals were based on progression-free survival improvements, but so far no overall survival benefit has been noted with the addition of bevacizumab to chemotherapy in any overall study population.^{2, 3, 4, 5}

In The Lancet Oncology, Amit Oza and colleagues¹ report the mature overall survival data from ICON7, an open-label randomised phase 3 trial comparing bevacizumab plus six 3-weekly cycles of carboplatin and paclitaxel chemotherapy followed by bevacizumab maintenance versus the carboplatin and paclitaxel chemotherapy regimen alone. The study participants were patients with newly diagnosed ovarian cancer following cytoreductive surgery or patients with advanced-stage disease who had no further surgery planned.¹ The primary endpoint of this trial, progression-free survival, has been reported previously.² Concordant with the results of GOG-218,³ another phase 3 trial comparing chemotherapy and bevacizumab versus chemotherapy alone in upfront therapy for ovarian cancer.....

 References

1. Oza, AM, Cook, AD, Pfisterer, J et al. Standard chemotherapy with or without bevacizumab for women with newly diagnosed ovarian cancer (ICON7): overall survival results of a phase 3 randomised trial. Lancet Oncol. 2015; (published online June 23.)http://dx.doi.org/10.1016/S1470-2045(15)00086-8.
2. Perren, TJ, Swart, AM, Pfisterer, J et al. A phase 3 trial of bevacizumab in ovarian cancer. N Engl J Med. 2011; 365: 2484–2496
3. Burger, RA, Brady, MF, Bookman, MA et al. Incorporation of bevacizumab in the primary treatment of ovarian cancer. N Engl J Med. 2011; 365: 2473–2483
4. Aghajanian, C, Blank, SV, Goff, BA et al. OCEANS: a randomized, double-blind, placebo-controlled phase III trial of chemotherapy with or without bevacizumab in patients with platinum-sensitive recurrent epithelial ovarian, primary peritoneal, or fallopian tube cancer. J Clin Oncol. 2012; 30: 2039–2045
5. Pujade-Lauraine, E, Hilpert, F, Weber, B et al. Bevacizumab combined with chemotherapy for platinum-resistant recurrent ovarian cancer: the AURELIA open-label randomized phase III trial. J Clin Oncol. 2014; 32: 1302–1308
6. Coleman, R, Burger, RA, Brady, MF et al. Analysis of survivorship in high-risk patients on treated on GOG-218. Gynecol Oncol. 2013; 130: e112–e113
7. Katsumata, N, Yasuda, M, Isonishi, S et al. Long-term results of dose-dense paclitaxel and carboplatin versus conventional paclitaxel and carboplatin for treatment of advanced epithelial ovarian, fallopian tube, or primary peritoneal cancer (JGOG 3016): a randomised, controlled, open-label trial. Lancet Oncol. 2013; 14: 1020–1026
8. Chan, J, Brady, MF, Penson, RT et al. Phase III trial of every-3-weeks paclitaxel versus dose dense weekly paclitaxel with carboplatin +/- bevacizumab in epithelial ovarian, peritoneal, fallopian tube cancer: GOG 262 (NCT0116712). Int J Gynecol Cancer. 2013; 23: 9–10
9. Kehoe, S, Hook, J, Nankivell, M et al. Primary chemotherapy versus primary surgery for newly diagnosed advanced ovarian cancer (CHORUS): an open-label, randomised, controlled, non-inferiority trial. Lancet. 2015; (published online May 19.)http://dx.doi.org/10.1016/S0140-6736(14)62223-6.
10. Vergote, I, Trope, CG, Amant, F et al. Neoadjuvant chemotherapy or primary surgery in stage IIIC or IV ovarian cancer. N Engl J Med. 2010; 363: 943–953