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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Answer

Bevacizumab

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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