Letter: Bevacizumab in Ovarian Cancer — NEJM

Bevacizumab in Ovarian Cancer — NEJM

Correspondence

Bevacizumab in Ovarian Cancer

N Engl J Med 2012; 366:1256-1258  March 29, 2012

Article

To the Editor:

In their article on the findings of the Gynecologic Oncology Group study GOG-0218 (ClinicalTrials.gov number, NCT00262847), Burger et al. (Dec. 29 issue)1 state, as have others in a similar context,2 that the potential to see differences in overall survival in an ovarian cancer trial is limited by post-progression therapies, including crossover to the experimental agent bevacizumab. Post-progression therapies will attenuate differences in overall survival that would be seen if such therapies did not exist, but the observed attenuated differences are the correct measure of clinical benefit for the patients provided that standard-of-care post-progression therapies are used in both treatment groups.3,4

This would seem to be the case in the Gynecologic Cancer InterGroup (GCIG) International Collaboration on Ovarian Neoplasms (ICON7) bevacizumab trial (NCT00483782) reported by Perren et al. (also in the Dec. 29 issue),5 in which less than 4% of the patients in the control group received post-progression antiangiogenic treatments. To interpret the GOG-0218 results, one would need to know how many patients received post-progression antiangiogenic treatments. However, if one considered bevacizumab a standard treatment for progressing (recurrent) ovarian cancer given that it has shown activity, is recommended by National Comprehensive Cancer Network guidelines, and is covered by Medicare, then the observed difference in overall survival seen in the GOG-0218 and ICON7 trials1,5 is the appropriate estimate of clinical benefit for overall survival, regardless of post-progression treatments.

Edward L. Korn, Ph.D.
Boris Freidlin, Ph.D.
Jeffrey S. Abrams, M.D.
National Cancer Institute, Bethesda, MD
korne@ctep.nci.nih.gov

Expert Perspectives in Oncology: Contemporary Approaches in Targeting Angiogenesis prIME Oncology

Note: requires registration to view (free), also speaks about ICON 7 (ovarian cancer/avastin trial) Module Six Practical Considerations in Patient Management Involving Antiangiogenic Therapy

new research: ICON7 Results May Change Practice in Ovarian Cancer | Cancer Survivors Network

OncologySTAT: Dr. Cervantes, what were the most important studies in ovarian cancer that were presented at this year’s ESMO Congress?

Prof Timothy Perren - Leeds Teaching Hospitals NHS Trust, UK, The ICON7 trial on ecancer tv (Avastin)

ESMO - ICON 7 - Avastin Shows Promise For Ovarian Cancer Treatment

Further evidence that Avastin improved progression free survival in women with ovarian cancer was presented by researchers at the European Society of Medical Oncology (ESMO) congress in Milan, Italy. A new Phase III Avastin (ICON7) trial showed again that women with chemotherapy-naïve ovarian cancer had better progression free survival compared to women only on chemotherapy. A chemotherapy-naïve patient is one who has never received chemotherapy.

ICON7 is the second Phase III clinical trial on Avastin for ovarian cancer treatment. It compared chemotherapy-naïve women on Avastin plus chemotherapy versus similar patients on just chemotherapy. PFS (progression free survival) was approximately 27% better among those in the Avastin group; this corresponded to a 21% drop in the chances of cancer progression to death, the investigators explained. GOG0218, the first Phase III pivotal Avastin trial, had demonstrated earlier this year that Avastin plus chemotherapy and then alone gave ovarian cancer patients a 54% higher chance of progression free survival compared to women on chemotherapy alone.The Avastin dosage was smaller in the ICON7 trial, which also lasted less time....cont'd

www.icon7trial.org - Avastin trial

Data from ICON7 will be submitted for presentation at an upcoming medical meeting, Genentech said.

The ICON7 study is sponsored by the Medical Research Council (MRC) in the UK, led by the MRC Clinical Trials Unit and conducted through an international network of researchers in the Gynaecologic Cancer InterGroup (GCIG).

ICON7 is an international, multicentre, randomised, open-label, Phase III study in 1,528 women with previously untreated epithelial ovarian, primary peritoneal or fallopian tube carcinoma. The trial evaluates Avastin plus standard of care chemotherapy (carboplatin and paclitaxel) followed by the continued use of Avastin alone, compared to chemotherapy alone.