Treatment Options in Ovarian Cancer

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The use of single-agent therapy in ovarian cancer is not currently supported by strong evidence. James Tate Thigpen, MD, describes the ICON4 study, which compared a single agent platinum-based agent with a taxane in combination with a platinum agent. The study showed dramatically less myelosuppression overall with the combination, but more neuropathy. The overall toxicity rates were not dramatically different between the two cohorts, explains Thigpen.

The toxicity experienced with a taxane is different than experienced with a platinum-based agent, Thigpen notes. This variation in adverse events could allow for the personalization of treatment, dependent on what kind of toxicity the patient is going to be able to tolerate.

The use of bevacizumab in the frontline, platinum-sensitive, and platinum-resistant settings has demonstrated a persistent progression-free survival (PFS) advantage. Given these consistent results, Thigpen states that bevacizumab should be a component of standard therapy beyond just clinical trials for ovarian cancer.

In November 2014, the FDA approved bevacizumab in combination with chemotherapy for patients with platinum-resistant recurrent ovarian cancer. This decision was based on a 62% improvement in PFS experienced by patients treated with the VEGF inhibitor in the phase III AURELIA trial. Median PFS with bevacizumab was 6.8 versus 3.4 months with chemotherapy alone (HR = 0.38; P <.0001).