Medscape: (Avastin) Bevacizumab: First-Line Therapy in Ovarian Cancer?: Evidence for First-Line Therapy Dr's Markman, Burger, Swenterton

Bevacizumab: First-Line Therapy in Ovarian Cancer?: Evidence for First-Line Therapy

Editor’s Note:
 
Two phase 3 trials published in the New England Journal of Medicine on December 29, 2011, found bevacizumab to be active as first-line therapy in advanced ovarian cancer. Although both trials showed an increase in progression-free survival [PFS], not enough time has elapsed to determine whether the drug extends overall survival. Furthermore, it is unclear whether bevacizumab in ovarian cancer is best used as first-line or second-line therapy. Recently, Drs. Robert Burger and Kenneth Swenerton participated in a Medscape virtual debate via email to address this question: "Should bevacizumab be used as first-line therapy in patients with advanced ovarian cancer?" Dr. Maurie Markman served as moderator. What follows is their conversation......

abstract: First-line Chemotherapy in Epithelial Ovarian Cancer : Clinical Obstetrics and Gynecology

Abstract

"Advanced-stage epithelial ovarian cancer remains a highly lethal malignancy, despite effective cytoreductive surgery and primary chemotherapy. Phase III studies have evaluated multidrug combinations, dose-dense weekly scheduling, intraperitoneal delivery, neoadjuvant chemotherapy, maintenance therapy, and targeting of angiogenesis. Incremental gains in median progression-free or overall survival have been achieved, but without an impact on overall mortality. Data support intraperitoneal cisplatin, dose-dense weekly paclitaxel, or neoadjuvant chemotherapy with interval cytoreduction in appropriate patients. Encouraging data have emerged using antiangiogenic agents, but with questions regarding optimal timing and patient selection. The use of 3-drug combinations or maintenance chemotherapy is not supported."

abstract: Tumor Type and Substage Predict Survival in Stage I and II Ovarian Carcinoma: Insights and Implications

"Tumor grade has been the most accepted prognostic indicator of disease-specific survival among women with stage I and II ovarian carcinomas. Many investigators have included stage IB, grade 1 at diagnosis as low-risk disease and have suggested that women in this category should not receive adjuvant therapy. However, grading assignment appears to be unreliable because of problems with reproducibility and lack of consideration of biological differences between the different tumor types. Some investigators believe that classification based on tumor typing using new histopathological criteria was more reproducible than grade assignment and would more accurately reflect biological differences..."cont'd

Front-line Bevacizumab in Serous Epithelial Ovarian Cancer: Biomarker Analysis of the FINAVAST Trial — Anticancer Research

Background: Potential tissue and serum biomarkers were assessed for predicting efficacy of bevacizumab in ovarian cancer (OC).

Conclusion: Our results indicate differences in MMP-9 and HIF-1α expression in relation to duration of PFS (progression free survival) and effects on serum VEGF when bevacizumab (Avastin) is used in combination with chemotherapy.