Expert Point of View: Rebecca Kristeleit, MD

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Formal discussant of the AURELIA and ICON7 presentations, Rebecca Kristeleit, MD, University College London Hospital, London, said that a consistent message in both trials was the benefit of bevacizumab (Avastin) in high-risk disease.

“Angiogenesis seems to be a particular driver of advanced disease, enabling growth and metastasis in the peritoneal space. The rationale for adding bevacizumab to chemotherapy is to accomplish a twofold normalization of vasculature, to starve the tumor,” she explained.

Specific Considerations

ICON7 showed that in the high-risk subgroup, bevacizumab was of benefit. This included women with residual or stage IV disease, and those who had not undergone surgery. But in stage III patients with no residual disease, no benefit was seen with the addition of bevacizumab.

“The [progression-free and overall survival differences] are clinically meaningful and statistically significant [in the high-risk patients],” Dr. Kristeleit stated. “There is no survival benefit in any of the other subgroups.”

“However, bevacizumab doesn’t improve the cure rate. A remaining question is whether maintenance therapy will improve survival, she said.

Turning to AURELIA, she said, “The bottom line is that the [progression-free survival] doubled in this hard-to-treat ovarian cancer group where there is significant clinical need. The best survival results in the weekly paclitaxel group were seen in an exploratory analysis, and the true benefit of bevacizumab is difficult to tease out.” The study suggests that patients relapsing within 3 months of platinum therapy may not have the same benefit from the addition of bevacizumab, she pointed out.

‘Practice-Changing’ Studies

Dr. Kristeleit called AURELIA and ICON7 “practice-changing.”

She continued, “Bevacizumab with weekly paclitaxel should be considered a new paradigm in platinum-resistant ovarian cancer. This combination has the most favorable clinical and cost-benefit ratio…. And first-line therapy with bevacizumab and 3-weekly chemotherapy should be considered a standard of care in high-risk ovarian cancer.” ■

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

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