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Would you share about the current status of bevacizumab (Avastin) for treating ovarian cancer and where it may fit in the treatment algorithm?
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DonDizonMD (Physician - Oncology - Hematology/Oncology (Verified) ) - 06 / 29 / 2012
I am convinced that bevacizumab is a really good drug to treat ovarian cancer. In combination with chemotherapy it improves progression free survival when given as part of first-line treatment and in the treatment of women who relapse greater than six months from the end of primary treatment (platinum sensitive disease). In both of these settings, however, there is no evidence that bevacizumab results in improvement in overall survival.
At the 2012 ASCO meeting, the results of the AURELIA study were presented which looked at chemotherapy with or without bevacizumab in women who relapse less than six months (platinum resistant disease). In this context, bevacizumab again improves response rates and progression free survival when used with chemotherapy (particularly paclitaxel). Given that women who relapse early tend to have symptoms of their disease, these results may translate in to a quality of life benefit, although the impact of bevacizumab on quality of life was not reported in the AURELIA study. In addition, whether or not bevacizumab prolongs survival in this context was not presented either, but even if we don't see an improvement in overall survival I think the improvements in response rate and progression free survival are clinically meaningful in the woman with platinum-resistant disease. So, my preference is to use it in the setting of recurrent ovarian cancer and in particular, in women with platinum-resistant disease. Some of my colleagues use it in the upfront (adjuvant) and in the setting of platinum-sensitive recurrence, which I think is fine too. Of note, bevacizumab is already approved for use in newly diagnosed patients in Europe.
At the 2012 ASCO meeting, the results of the AURELIA study were presented which looked at chemotherapy with or without bevacizumab in women who relapse less than six months (platinum resistant disease). In this context, bevacizumab again improves response rates and progression free survival when used with chemotherapy (particularly paclitaxel). Given that women who relapse early tend to have symptoms of their disease, these results may translate in to a quality of life benefit, although the impact of bevacizumab on quality of life was not reported in the AURELIA study. In addition, whether or not bevacizumab prolongs survival in this context was not presented either, but even if we don't see an improvement in overall survival I think the improvements in response rate and progression free survival are clinically meaningful in the woman with platinum-resistant disease. So, my preference is to use it in the setting of recurrent ovarian cancer and in particular, in women with platinum-resistant disease. Some of my colleagues use it in the upfront (adjuvant) and in the setting of platinum-sensitive recurrence, which I think is fine too. Of note, bevacizumab is already approved for use in newly diagnosed patients in Europe.
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