Frontline management of ovarian cancer typically includes 6 cycles of chemotherapy with paclitaxel, carboplatin, and bevacizumab followed by bevacizumab maintenance therapy until disease progression, states Robert L. Coleman, MD. It remains unclear whether frontline bevacizumab should be continued indefinitely, specifically if patients are not having symptoms from their cancer in the maintenance setting, comments Angeles Alvarez Secord, MD.
A retrospective analysis of data from the ICON7 study revealed a potential biomarker that could be used to tailor therapy. In this investigation, patients with high-grade serous ovarian cancer with an immune gene upregulation and angiogenic gene repression experienced worse outcomes with the addition of bevacizumab. For patients with this signature (41%), the addition of bevacizumab conferred a worse PFS (HR = 1.73) and OS (HR = 2.00) compared with chemotherapy alone. Women in this immune molecular subgroup had degradation in survival when treated with bevacizumab, explains Thomas Herzog, MD. This information reveals that not only does bevacizumab therapy not benefit this group but may cause harm from toxicity and cost.
In addition to detecting those unlikely to respond, it is also critical to find patients who are appropriate for treatment with bevacizumab, adds Secord. Clinical trial have shown indicators that may help identify individuals most likely to benefit from bevacizumab, explains Secord, such as information about patients with ascites. The use of this data in combination with information from molecular biomarkers and tissue-based studies could help develop a tool that selects patients for bevacizumab treatment, says Secord.