Benoit You, MD, PhD, on Ovarian Cancer: Who Benefits From Bevacizumab in the First-Line Setting
2022 ASCO Annual Meeting
Benoit You, MD, PhD, of Lyon University hospital (HCL, France) and GINECO group (France), discusses findings from the GOG-0218 trial of patients with ovarian cancer, which appears to confirm earlier data on the link between poor tumor chemosensitivity and benefit from concurrent plus maintenance bevacizumab. In Dr. You’s validation study, patients who derived the most progression-free and overall survival benefit from bevacizumab were those with high-risk disease (stage IV or incompletely resected stage III) associated with an unfavorable KELIM score (CA-125 kinetic elimination rate constant, calculable online) (Abstract 5553).
Transcript
Disclaimer: This video transcript has not been proofread or edited and may contain errors.
I presented the results of a validation study done in collaboration with the U.S. GOG group about the patients with ovarian carcinoma who have the maximum benefit from bevacizumab. Bevacizumab has been approved for patients with ovarian carcinoma stage 3 and stage 4. However, there is still a big debate about what patients should actually be treated with bevacizumab, because two main large phase III trials had inconsistent outcomes about the characteristics of patients who had a maximum overall survival benefit, and there was no real biomarker of bevacizumab efficacy. So we assume that the tumor primary chemosensitivity, meaning the sensitivity of the tumor to the first cycle of chemotherapy assessed by the model CA-125 kinetic parameter KELIM, could be an interesting parameter. In an initial study with ICON7 trial, we found that among patients with high-risk disease, meaning stage 3 incompletely resected and stage 4 disease, only those who had unfavorable KELIM score, meaning poly-chemosensitive disease, had the benefit from bevacizumab. So, a validation was needed, and this is what we did with the U.S. GOG group on the trial, the GOG-0218 trial. KELIM was assessed by our team, and then we sent the KELIM score to the statistic team of the GOG group. We had very consistent outcomes. In patients with high-risk disease, only those who had unfavorable KELIM score, meaning poly-chemosensitive disease, had the benefit in overall survival by about 6 months, 29 to 35 months. And in patients with low-risk disease, those who had favorable KELIM, meaning highly chemosensitive disease, they had deleterious effect of bevacizumab on the overall survival by about 17 months. So, in conclusion, the two studies are now very consistent in terms of outcomes. We reconcile the data of the two trials. The survivor cures are very, very similar, and we consider that the tumor primary chemosensitivity is probably a biomarker of bevacizumab efficacy. So bevacizumab should be encouraged in patients with high-risk disease and poly-chemosensitive disease, but should be discouraged in patients with low-risk disease and highly chemosensitive disease. Just of note, KELIM can be calculated online for your patient. You will be requested to enter the dates of the first three cycles of chemotherapy, the value of CA-125, and the dates of CA-125. You press compute and you will have the KELIM score for your patients.
Related Videos
The ASCO Post Staff
Andrew D. Zelenetz, MD, PhD, of Memorial Sloan Kettering Cancer Center, and Michael L. Wang, MD, of The University of Texas MD Anderson Cancer Center, discuss primary results from the phase III SHINE study, which showed that ibrutinib, in combination with bendamustine/rituximab and rituximab maintenance, may set a new benchmark for patients aged 65 or older with mantle cell lymphoma. With a median progression-free survival of 6.7 years, the ibrutinib combination is more beneficial than currently used chemoimmunotherapy (approximately 1.5–3.5 years) (Abstract LBA7502).
The ASCO Post Staff
Mairéad G. McNamara, PhD, MBBCh, of The Christie NHS Foundation Trust, discusses phase II findings of the NET-02 trial, which explored an unmet need in the second-line treatment of patients with progressive, poorly differentiated extrapulmonary neuroendocrine carcinoma. In the trial, the combination of liposomal irinotecan, fluorouracil, and folinic acid, but not docetaxel, met the primary endpoint of 6-month progression-free survival rate (Abstract 4005).
The ASCO Post Staff
Martin McCabe, PhD, of the University of Manchester, discusses a phase III assessment of chemotherapy for patients with recurrent and primary refractory Ewing sarcoma. The trial, called rEECur, is the first study to provide comparative toxicity and survival data for the four most commonly used chemotherapy regimens in this disease. The analysis showed that high-dose ifosfamide is more effective in prolonging survival than topotecan plus cyclophosphamide (Abstract LBA2).
The ASCO Post Staff
Stephanie Walker, a former nurse and current activist with the Metastatic Breast Cancer Alliance, discusses findings from the BECOME project (Black Experience of Clinical Trials and Opportunities for Meaningful Engagement). They show that, even though Black patients comprise between 4% and 6% of all clinical trial participants, Black women with metastatic breast cancer are willing to consider taking part if steps were taken to increase their awareness, build trust through clear communication with health-care providers, involve people of shared racial/ethnic identity and health experience, and help patients find and access trials (Abstract 1014).
The ASCO Post Staff
Lisa A. Carey, MD, of the University of North Carolina Lineberger Comprehensive Cancer Center, and Shanu Modi, MD, of Memorial Sloan Kettering Cancer Center, discuss the phase III findings from the DESTINY-Breast04 trial, which compared fam-trastuzumab deruxtecan-nxki (T-DXd) vs treatment of physician’s choice (TPC) in patients with HER2-low unresectable and/or metastatic breast cancer. T-DXd is the first HER2-targeted therapy to demonstrate clinically meaningful improvement in progression-free and overall survival compared with TPC in this patient population, regardless of hormone receptor or immunohistochemistry status or prior use of CDK4/6 inhibitors (Abstract LBA3).