Patient Selection for Bevacizumab in Ovarian Cancer

Transcript:Thomas Herzog, MD: Patient selection is very important when entertaining putting a patient on bevacizumab. I think it’s important to remember that the 2 phase III trials that led to approval in the platinum-sensitive space included patients with a good performance status. These patients by-and-large, especially with GOG-213 where we knew more about patient selection, were not patients who had a history of inflammatory bowel disease or bowel obstruction or impending bowl obstruction. And with doing that, we can definitely decrease the amount of GI toxicity, such as perforations, that we see with these patients. The other thing is understanding their background, past medical history, and concurrent diseases, such as hypertension. I think it’s important to monitor their blood pressure carefully during treatment, and we find that we’re able to keep patients on the right dose without dose delays with progressive blood pressure monitoring and intervention.

The efficacy is very good. I have had patients who’ve had complete responses in the platinum-sensitive setting. I have seen patients who’ve had large volume ascites who’ve had near complete resolution. I’ve had patients with pleural effusions who have had near complete responses as well in this setting. And I think that is exhibited by the data where, again, you go from the mid 50% to the chemotherapy regimen, and by adding bevacizumab, you bring that up by about 20%. So, it’s impressive, and that’s what patients want to see as well. They want to come in, they want to see that their CA-125 is going down, and that their symptoms are diminishing. That’s very important to the patient.

For me, there’s an important decision to make with administering bevacizumab in the platinum-sensitive setting, and that’s really asking what chemotherapy backbone am I going to use? Am I going to use carboplatin with gemcitabine? Or am I going to use carboplatin with paclitaxel? And I have to look at a number of variables to make that decision. One of the things I look at is what the treatment-free interval has been. Longer makes me tend to go more with carboplatin/paclitaxel versus carboplatin and gemcitabine. I also look at the logistics of the schedule. The gemcitabine is administered on a day 1/day 8 schedule. The paclitaxel could be administered weekly, but in GOG-213, it was given every 3 weeks, which can be an advantage for some patients who don’t want to have to come into the medical center as often. Then, I also look at, what kind of symptoms did the patient incur from their frontline treatment? So, for patients who have a lot of neuropathy, for example, that’s a perfect candidate, in my mind, to go with the platinum and gemcitabine.

Transcript Edited for Clarity