Cancer Treatment Today

Lay Summary: Avastin appears to add to combination chemotherapies for ovarian cancer.

Patients with ovarian cancer that has recurred or progressed following prior therapies, have unfavorable long-term outcomes with standard therapies. Although additional chemotherapy can be used to treat these patients, they often have minimal anti-cancer responses as well as side effects from treatment. Initial study of Avastin focused on this unfavourable group. Researchers from California conducted a study to evaluate the effectiveness of Avastin for the treatment of recurrent ovarian cancer. This trial included 33 patients who had received extensive prior chemotherapy. The majority of patients were treated with Avastin as a single agent. This is the 3rd positive phase II trial. The previous trials included Avastin with metronomic cyclophosphamide and one with a taxane. A phase III trial, however, was stopped by Genetech when an unexpected 11% of participants developed bowel perforations. The debate about why this happened and how it was related to the patient characteristics still has not been resolved.

Patients with ovarian cancer that has recurred or progressed following prior therapies, have unfavorable long-term outcomes with standard therapies. Although additional chemotherapy can be used to treat these patients, they often have minimal anti-cancer responses as well as side effects from treatment. Initial study of Avastin focused on this unfavourable group. Researchers from California conducted a study to evaluate the effectiveness of Avastin for treatment of recurrent ovarian cancer. This trial included 33 patients who had received extensive prior chemotherapy. The majority of patients were treated with Avastin as a single agent. This is the 3rd positive phase II trial. The previous trials included Avastin with metronomic cyclophosphamide and one with a taxane. A phase III trial, however, was stopped by Genetech when an unexpected 11% of participants developed bowel perforations. The debate about why this happened and how it was related to the patient characteristics still has not been resolved. Nevertheless, based on the existing evidence, NCCN has now added Avastin to its list of recommended drugs for ovarian cancer.

NCCN supports second line use of Avastin alone or in combination , but the only combination that it mentions specifically is gemcitabine/carboplatin/bevacizumab and carboplatin liposomal doxorubicin with or without Avastin. The discussion of the guidelines at MS-14 (makes it clear that this is the correct interpretation of teh OV-E page. Carboplatin plus gemcitabine with or without bevacizumab has recently been published as the OCEANS trial (Aghajanian et al). This study showed a higher response rate and a slightly prolonged time to recurrence with the addition of bevacizumab. However, overall survival was identical. Therefore, this regimen has received only a category 2B level of evidence in NCCN guidelines.

Perren T, Swart AM, Pfisterer J, et al: ICON7: A phase III randomized gynaecologic cancer intergroup trial of concurrent bevacizumab and chemotherapy followed by maintenance bevacizumab versus chemotherapy alone in women with newly diagnosed epithelial ovarian cancer, primary peritoneal cancer, or fallopian tube cancer. Program and abstracts of the 35th European Society for Medical Oncology (ESMO) Congress; October 8-12, 2010; Milan, Italy. Abstract LBA4.

Burger RA, Brady MF, Bookman MA, et al. Phase III trial of bevacizumab (BEV) in the primary treatment of advanced epithelial ovarian cancer (EOC), primary peritoneal cancer (PPC), or fallopian tube cancer (FTC): A Gynecologic Oncology Group study. J Clin Oncol. 2010;28:abstract LBA1, ASCO Annual Meeting Proceedings (Post-Meeting Edition). Available at: http://meeting.ascopubs.org/cgi/content/abstract/28/18_suppl/LBA1

Monk B, Han E, Josephs-Cowan C, et al. Salvage Bevacizumab (rhuMAB VEGF)-based Therapy after Multiple Prior Cytotoxic Regimens in Advanced Refractory Epithelial Ovarian Cancer. Gynecologic Oncology. 2006; 102: 140-144.

Bidus MA, Webb JC, Seidman JD, et al. Sustained response to bevacizumab in refractory well-differentiated ovarian neoplasms.Gynecologic Oncology. 2006;May 11

Cohn DE, Valmadre S, Resnick KE, et al. Bevacizumab and weekly taxane chemotherapy demonstrates activity in refractory ovarian cancer. Gynecologic Oncology. 2006;March 7

Robert A. Burger, Experience With Bevacizumab in the Management of Epithelial Ovarian Cancer, Journal of Clinical Oncology, Vol 25, No 20 (July 10), 2007: pp. 2902-2908

Burger R, Brady MF, Bookman MA, et al: Phase III trial of bevacizumab (BEV) in the primary treatment of advanced epithelial ovarian cancer (EOC), primary peritoneal cancer (PPC), or fallopian tube cancer (FTC): A Gynecologic Oncology Group study. 2010 ASCO Annual Meeting. Abstract LBA1. Presented June 6, 2010.

Cohn DE, Valmadre S, Resnick KE, et al. Bevacizumab and weekly taxane chemotherapy demonstrates activity in refractory ovarian cancer. Gynecologic Oncology. 2006;March

Daniela Luvero et al, Treatment options in recurrent ovarian cancer: latest evidence and clinical potential. Ther Adv Med Oncol. 2014 Sep; 6(5): 229239 7;

NCCN Ovarian Cancer OV-C, 6 of 8, 2019