Chemotherapy plus bevacizumab prolongs PFS in recurrent ovarian cancer
Adding bevacizumab to platinum-based chemotherapy significantly improves progression-free survival (PFS) in patients with recurrent ovarian cancer who were previously treated with first-line bevacizumab, according to the MITO16B - MaNGO OV2B - ENGOT OV17* study presented at ASCO 2018.
This phase III trial evaluated 405 patients (median age 61 years) with stage IIIB/IV ovarian cancer who relapsed within 6 months after the last cycle of platinum-based chemotherapy. Participants were randomized in a 1:1 ratio to receive platinum-based chemotherapy for six cycles plus bevacizumab to be continued until disease progression (experimental arm, n=202) or platinum-based chemotherapy only (standard arm, n=203). The chemotherapy options were carboplatin + paclitaxel (n=42), carboplatin + gemcitabine (n=197), or carboplatin + pegylated liposomal doxorubicin (n=166). [ASCO 2018, abstract 5506]
After a median follow-up of 20.3 months, 304 PFS events and 147 deaths occurred.
Compared with those on chemotherapy only, patients treated with chemotherapy + bevacizumab experienced significantly longer PFS (median, 11.8 vs 8.8 months, hazard ratio [HR], 0.51; p<0.001).
Of note, the complete response rate was doubled among patients in the chemotherapy + bevacizumab group vs chemotherapy only group (15.4 percent vs 6.3 percent), while partial response rate was comparable between the two treatment groups (59.2 percent vs 59.4 percent, respectively).
There was no significant difference in the overall survival rate between the chemotherapy + bevacizumab and chemotherapy only groups (median, 26.6 and 27.1 months, respectively, HR, 0.97; p=0.98), although these results are not yet mature, said study lead author Dr Sandro Pignata from the National Cancer Institute in Naples, Italy.
Grade 3 hypertension and proteinuria occurred more frequently in the chemotherapy + bevacizumab group than the chemotherapy only group (28.9 percent vs 10.0 percent and 3.9 percent vs 0.0 percent, respectively). “In terms of safety, there was no unexpected toxicity in our study … and all the remaining toxic effects were in the range of what is expected,” said Pignata.
“Rechallenge with platinum-based chemotherapy and bevacizumab is a clinical option in recurring patients already treated with bevacizumab. Future translational analyses will provide a deeper insight into prognostic and predictive factors, and the results are expected at the end of this year,” he added.
*MITO16B - MaNGO OV2B - ENGOT OV17: Bevacizumab beyond progression in platinum sensitive ovarian cancer