Bevacizumab Plus Chemo Ups Ovarian Cancer Survival


American Society of Clinical Oncology 2010 Annual Meeting

Major Finding: There was a 3.8-month increase in progression-free survival in women with advanced ovarian and related cancers who received bevacizumab as an adjunct and follow-on to standard chemotherapy.

Data Source: GOG-0218 trial.

Disclosures: Dr. Burger has served as an advisor/consultant to Genentech Inc. Dr. Eisenhauer reports no relevant disclosures.

CHICAGO — Progression-free survival in women with advanced ovarian or related female reproductive tract cancers was increased by nearly 4 months when they received frontline therapy with standard chemotherapy and concurrent bevacizumab followed by maintenance with bevacizumab alone, reported investigators from the Gynecologic Oncology Group's GOG-0218 trial.

In a randomized, placebo-controlled, phase III trial, the addition of bevacizumab (Avastin) to chemotherapy with carboplatin and paclitaxel followed by bevacizumab monotherapy resulted in a median progression-free survival (PFS) of 14.1 months, compared with 10.3 months for women on standard chemotherapy and placebo (hazard ratio 0.717, P less than .0001), reported lead investigator Dr. Robert A. Burger of the Fox Chase Cancer Center in Philadelphia.

But bevacizumab was effective only when used both as an adjunct to chemotherapy and as maintenance therapy: Women who received the angiogenesis inhibitor with chemotherapy but got a placebo during the maintenance phase had a median progression-free survival of 11.2 months, which was not significantly better than that of women who received chemotherapy and placebo only (HR 0.98, P=.16), Dr. Burger said.

“Bevacizumab is the first molecular-targeted and first antiangiogenic agent to demonstrate benefit in this population, and bevacizumab combined with chemotherapy followed by bevacizumab maintenance should be considered as one standard option for women with this disease,” said Dr. Burger.

That recommendation may be a bit premature, however, because the data so far show an effect of bevacizumab on only progression-free survival and not on overall survival, and “we cannot infer that a progression-free survival gain will mean an overall survival gain,” commented Dr. Elizabeth A Eisenhauer, the invited discussant.

“A progression-free survival gain of only 3.8 months may not be meaningful to patients. We need the mature overall survival and quality-of-life results, and ideally the results of the other frontline trial of bevacizumab in this disease, ICON-7, to understand the full story of the impact of this advance,” said Dr. Eisenhauer of the National Cancer Institute of Canada.

GOG-0218 investigators enrolled 1,873 women with stage III or IV epithelial ovarian cancer, primary peritoneal cancer, or fallopian tube cancer.

Each group received the CT regimen, consisting of 22 3-week cycles, with the first 6 cycles consisting of intravenous paclitaxel 175 mg/m

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