The addition of bevacizumab (Avastin) to chemotherapy improved progression-free survival and response rates in patients with platinum-resistant recurrent ovarian cancer, according to an exploratory analysis of the phase III AURELIA trial. The combination of paclitaxel with bevacizumab achieved very good results in terms of response rate and progression-free survival, but the effect of the addition of bevacizumab was seen also with pegylated liposomal doxorubicin (Doxil) and topotecan and was of the same magnitude.

For the overall trial, median progression-free survival was 6.7 months for bevacizumab plus chemotherapy vs 3 months for chemotherapy alone. For the paclitaxel cohort, median progression-free survival was 10.4 months vs 3.9 months; for the liposomal doxorubicin cohort, median progression-free survival was 5.4 months vs 3.4 months; and for the topotecan cohort, median progression-free survival was 5.8 months vs 2.1 months.

According to lead author Andrés M. Poveda, MD, head of the Oncogynecology Department, Fundación Instituto Valenciano de Oncologia, Valencia, Spain, “Bevacizumab combined with chemotherapy should be considered a new standard option for platinum-resistant recurrent ovarian cancer.”

Study Design

AURELIA randomly assigned 361 patients with platinum-resistant recurrent ovarian cancer to chemotherapy alone (investigator’s choice among weekly paclitaxel, liposomal doxorubicin, or topotecan) vs chemotherapy plus bevacizumab. Treatment was continued until unacceptable toxicity or progressive disease occurred.

All patients enrolled in the trial had platinum-resistant ovarian cancer that progressed on up to two prior chemotherapy regimens. Baseline characteristics were well balanced between the treatment arms. Median age was around 60 years, and about 90% had stage III/IV disease. Minor differences were observed, including higher number of prior regimens in the weekly paclitaxel groups.

Responses and Toxicities

Superior response rates for all three chemotherapy options were seen in bevacizumab and chemotherapy vs the chemotherapy alone arms, with the highest respons  rates observed in the weekly paclitaxel cohort: 51.7%, vs 28.8e. Overall response rates in the other two cohorts were: 18.3% and 7.9%, respectively, for the liposomal doxorubicin cohort and 5.8% and 2.1%, respectively, for the topotecan cohort.

The toxicity profiles of the various cohorts were consistent with previous studies and basically similar between the two main treatment arms. Patients in the weekly paclitaxel cohort had a higher rate of peripheral neuropathy, and those in the liposomal doxorubicin cohort had a higher rate of hand-foot syndrome. ■

Disclosure: Dr. Poveda reported no potential conflicts of interest.

References

1. Poveda AM, Selle F, Hilpert F, et al: Weekly paclitaxel (PAC), pegylated liposomal doxorubicin (PLD), or topotecan (TOP) + bevacizumab (BEV) in platinum (PT)-resistant recurrent ovarian cancer (OC). Analysis by chemotherapy (CT) cohort in the GCIG AURELIA randomized phase III trial. 2012 ESMO Congress. Abstract LBA26. Presented September 30, 2012.