Epithelial ovarian cancer accounts has a high rate of recurrence. Debulking surgery and six courses of platinum-based chemotherapy results in complete clinical remission (CCR) in up to 75% of cases. However, 75% of the responders will relapse within a median time of 18 to 28 months and only 20% to 40% of women will survive beyond five years. It has been suggested that maintenance chemotherapy could assist in prolonging remission. To date, there has not been a systematic review on the impact of maintenance chemotherapy for epithelial ovarian cancer. A recent meta-analysis concluded that there is no evidence to suggest that the use of platinum agents or doxorubicin used as maintenance chemotherapy is more effective than observation alone. Further investigations regarding the effect of paclitaxel used as maintenance chemotherapy are required.
Avastin as maintenance is being explored. A recent study showed that women who continued on “maintenance therapy” with Avastin, following Avastin and chemotherapy, showed no worsening of their disease for an average of 14.1 months. That compares with 10.3 months for women on chemo alone. A third group of women in the study took Avastin only during chemotherapy. They lived an average of 11.2 months before their cancer progressed, a difference that was not significantly different than chemo alone.
ICON7 trial was a randomized trial. The control arm of the trial was standard chemotherapy with carboplatin and paclitaxel given in the usual way for 6 cycles, 1 cycle of treatment every 3 weeks, and then no further treatment. In the research arm of the trial, patients were treated with chemotherapy and bevacizumab for 6 cycles and then received bevacizumab for a further 12 cycles of treatment, which made 18 cycles or 12 months of treatment in total. The primary endpoint for our trial was progression-free survival and the study showed that progression was delayed and occurred less frequently in patients treated with bevacizumab than in patients in the control arm.
Mei L, Chen H, Wei DM, Fang F, Liu GJ, Xie HY, Wang X, Zou J, Han X, Feng D.Maintenance chemotherapy for ovarian cancer. Cochrane Database Syst Rev. 2010 Sep 8;(9)
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).