What is the role of bevacizumab (Avastin) in the treatment of ovarian cancer?

Updated: Aug 10, 2020
  • Author: Andrew E Green, MD; Chief Editor: Yukio Sonoda, MD  more...
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The FDA has approved bevacizumab (Avastin) for patients with  stage III or IV epithelial ovarian, fallopian tube, or primary peritoneal cancer in combination with carboplatin and paclitaxel, followed by single-agent bevacizumab, after initial surgical resection. [87]  

In the OCEANS phase III study, women who received the combination of bevacizumab with chemotherapy had a 52% risk reduction for recurrence in disease progression (hazard ratio 0.48, P< 0.0001) compared with women who received chemotherapy alone. The study included women with recurrent, platinum-sensitive ovarian, peritoneal, or fallopian tube carcinoma, who received bevacizumab in combination with carboplatin and gemcitabine followed by continued use of bevacizumab alone until disease progression. [88]

Other results of the trial include a median progression-free survival of 12.4 months, compared with 8.4 months in women who received chemotherapy alone. Additionally, the overall response rate of tumor shrinkage was 79% in women receiving the bevacizumab-based regimen, compared with 57% in those who received chemotherapy alone. [88] However, on final analysis, median overall survival was not significantly different in patients who received bevacizumab and those who received placebo (33.6 versus 32.9 months, respectively; hazard ratio=0.95; log-rank p=0.65). [89]

A second phase III trial found adding bevacizumab to chemotherapy showed an overall survival difference of 5 months compared with paclitaxel plus carboplatin chemotherapy alone (median OS: 42.6 months vs. 37.3 months; Hazard Ratio (HR)=0.84, 95% CI: 0.69-1.01 and HR=0.82, 95% CI: 0.68-0.996). The GOG-0213 study showed that women lived a median of 3.4 months longer without disease progression with the addition of bevacizumab to chemotherapy compared with chemotherapy alone (median PFS: 13.8 months vs. 10.4 months; HR=0.61, 95% CI: 0.51-0.72). [90]

On May 2020, the FDA approved bevacizumab in combination with olaparib for first-line maintenance treatment in adults with advanced ovarian cancer who are in complete or partial response to first-line platinum-based chemotherapy and whose cancer is homologous recombination deficiency (HRD) positive, as defined by either a deleterious or suspected deleterious BRCA mutation, and/or genomic instability. [91]

Approval was based on the PAOLO-1 trial, an international, double-blind, and phase III trial that randomized patients (n=806) to either receive placebo or olaparib with bevacizumab. After a median follow-up of 22.9 months, the median PFS 22.1 months with olaparib plus bevacizumab and 16.6 months with placebo plus bevacizumab. In the subgroup patients with HRD-positive tumors without BRCA mutations, the median PFS was 28.1 months with olaparib/bevacizumab and 16.6 months with bevacizumab alone, respectively (HR=0.43; 95% CI, 0.28-0.66). Patients with HRD-positive tumors with BRCA mutation had a median PFS was 37.2 months in the olaparib plus bevacizumab group compared to bevacizumab alone (HR, 0.33; 95% CI, 0.25-0.45). [92]

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