Bevacizumab in Ovarian Cancer

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Resistance to platinum-based chemotherapy represents a major barrier in the effective treatment of ovarian cancer. At this point, research has not identified a treatment strategy that delays or reverses platinum resistance, although various schedules and administration routes have been attempted, notes Robert A. Burger, MD. As a result, strategies for patients with platinum-resistance disease have been developed, including VEGF inhibition.

In November 2014, the FDA approved bevacizumab in combination with chemotherapy as a treatment for patients with platinum-resistant recurrent ovarian cancer. This therapy is often used in this setting, particularly in combination with weekly paclitaxel, notes Warner K. Huh, MD.

In the pivotal AURELIA trial bevacizumab was administered in conjunction with pegylated liposomal doxorubicin, weekly paclitaxel, or topotecan. In the study, women who received bevacizumab plus paclitaxel (n = 60) experienced a median progression-free survival (PFS) of 9.6 versus 3.9 months with paclitaxel alone (HR = 0.47). In this same population, the median OS was 22.4 months with the combination versus 13.2 months with paclitaxel alone (HR = 0.64). This suggests synergy between bevacizumab and paclitaxel, Michael J. Birrer, MD, suggests.

In the platinum-sensitive setting, bevacizumab is commonly used in combination with gemcitabine and carboplatin. In Huh’s experience, there is a small fraction of patients who receive bevacizumab indefinitely. He adds that most women experience either disease progression or therapy-related toxicity that requires discontinuation of the drug.