Nisha Bansal, MD
Intravenous (IV) chemotherapy is the traditional chemotherapeutic approach for first-line treatment of patients with ovarian cancer, but there are many facets that go into determining the best strategy, said Nisha Bansal, MD.
Moreover, the June 2018 FDA approval of bevacizumab (Avastin) combined with chemotherapy in this setting following initial surgery could change up the landscape even more.
The choice of chemotherapy depends on several factors, such as whether a patient has had optimal surgery with no evidence of visible disease, and whether they have undergone upfront surgery or received neoadjuvant chemotherapy.
Nevertheless, efforts continue to bring improved and less toxic options to patients with ovarian cancer, one of which is bevacizumab. The angiogenesis inhibitor’s most recent approval is for use in combination with carboplatin and paclitaxel, followed by bevacizumab monotherapy, for the treatment of women with advanced ovarian cancer following initial surgical resection.
The approval is based on findings from the phase III GOG-0218 trial, in which the bevacizumab regimen reduced the risk of disease progression or death by 38% versus chemotherapy alone. The median progression-free survival (PFS) was 18.2 months versus 12.0 months, respectively (HR, 0.62; 95% CI, 0.52-0.75; P
Other trials have demonstrated the benefit of bevacizumab and were the basis for the drug’s initial approval for recurrent disease in 2014. In the OCEANS study, the median PFS with bevacizumab/chemotherapy versus placebo/chemotherapy in patients with platinum-sensitive recurrent ovarian cancer was 12.4 months versus 8.4 months, respectively (HR, 0.46; 95% CI, 0.37-0.58; P
The benefit was likewise reflected in the phase III AURELIA trial in which combining the agent with chemotherapy induced a 62% reduction in the risk of disease progression or death compared with chemotherapy alone in patients with platinum-resistant recurrent ovarian cancer.3