Continuing Bevacizumab Beyond Progression Improved PFS Compared With Chemo Alone for Recurrent Ovarian Cancer

Continuing treatment with bevacizumab (Avastin) beyond progression improved progression-free survival for patients with platinum-sensitive recurrent ovarian cancer compared with chemotherapy alone, according to data published in The Lancet Oncology.

The study sought to determine the value of continued bevacizumab treatment after progression following first-line treatment, suggesting this therapeutic path could be considered in clinical practice.

“Results from this study show that adding bevacizumab to a platinum-based doublet is safe and improves progression-free survival (PFS) in patients with platinum-sensitive recurrent ovarian cancer already treated with bevacizumab during first-line therapy,” wrote the investigators.

Out of an overall cohort of 406 patients randomized 1:1 to carboplatin-based chemotherapy with or without bevacizumab, the active therapy group featured 130 patients (64%) who progressed after receiving a last dose of platinum more than 1 year prior while 131 (65%) progressed in the standard chemotherapy group. Additionally, 146 patients (72%) and 147 patients (72%) in the bevacizumab and standard chemotherapy groups, respectively, progressed after completion of first-line bevacizumab maintenance.

For patients in the standard chemotherapy group, median PFS was 8.8 months (95% CI, 8.4-9.3) compared with 11.8 months (95% CI, 10.8-12.9) for patients in the bevacizumab group (HR, 0.51; 95% CI, 0.41-0.65; log-rank P < .0001).

The safety profile included common grade 3 or 4 adverse events of hypertension (10% in the standard chemotherapy group vs 29% in the bevacizumab group), neutrophil count decrease (41% vs 40%), and platelet count decrease (22% vs 30%).

Specifically, 68 patients (33%) from the standard chemotherapy group and 79 patients (39%) from the bevacizumab group died, with 2 deaths (1%) and 1 death (<1%) from the standard chemotherapy group and the bevacizumab group deemed to be treatment-related, respectively.

“Overall, the available evidence suggests that anti-angiogenetic treatment might be important in management of ovarian cancer alongside its clinical course, even in patients whose disease recurs after an initial anti-angiogenetic treatment,” wrote the investigators. “How to integrate such evidence with different, new therapeutic options and new knowledge on molecular characterisation of ovarian cancer remains the matter of current and future clinical trials.”

Patients were recruited to the study between December 6, 2013 and November 11, 2016. The primary end point of the data was investigator-assessed progression-free survival. The safety profile was also assessed among all patients receiving a minimum of 1 dose of treatment.

The research was limited by the open-label design without a placebo, as well as the focus on PFS as the study’s primary end point. More, the research team suggests that bias could be introduced in the bevacizumab group because of the more frequent hospital visits when compared with the standard chemotherapy group. The frequent hospital visits potentially could increase the chance of early detection in the bevacizumab group.

“The positive result of this study supports that bevacizumab can still be efficacious in second-line treatment, even in patients who already received it in first-line treatment,” wrote the investigators.

Reference:

Pignata S, Lorusso D, Joly F, et al. Carboplatin-based doublet plus bevacizumab beyond progression versus carboplatin-based doublet alone in patients with platinum-sensitive ovarian cancer: a randomised, phase 3 trial. Lancet Oncol 2021;22(2):267-276. doi:10.1016/S1470-2045(20)30637-9