Becavizumab may improve progression free survival in platinum-resistant ovarian cancer

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1. Combining bevacizumab with standard chemotherapy improved progression free survival and objective response rate in platinum-resistant ovarian cancer.

2. Adding bevacizumab did not significantly affect overall survival.

Evidence rating level: 1 (Excellent)

Study Rundown: Platinum-resistant recurrent ovarian cancer has an extremely poor prognosis, and is generally treated with single-agent chemotherapy with doxorubicin, paclitaxel or topotecan. Combinations of agents have demonstrated little benefit. The purpose of the AURELIA trial was to evaluate the effects of adding VEGF inhibitor bevacizumab to this regimen. At the conclusion of this trial, the authors found that progression free survival improved among all patient subgroups, while a non-statistically significant increase in overall survival was noted. Objective response rate also increased. The authors also found that adverse effects such as hypertension and proteinuria increased with bevacizumab therapy. Based on these results, they concluded that combined bevacizumab and standard chemotherapy should be considered a treatment option for recurrent ovarian cancer. However, these results are limited by the open-label design and lack of a third bevacizumab-alone arm.

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Relevant reading: Combined weekly topotecan and biweekly bevacizumab in women with platinum-resistant ovarian, peritoneal, or fallopian tube cancer: Results of a phase 2 study

In-Depth [randomized controlled trial]: The AURELIA trial was an open-label randomized phase III clinical trial. A total of 361 patients were enrolled, who had biopsy-proven ovarian cancer that had progressed within 6 months of completing platinum-based therapy. Patients were excluded if they had received more than two prior anticancer regimens or who had progression during previous cycles, prior radiotherapy, or those with particular risk factors for GI perforation. All patients received standard chemotherapy with 179 randomized to receive bevacizumab as well. Primary outcomes included progression-free survival (PFS), and secondary outcomes included objective response rate. The ORR was 11.8% and 27.3% in the standard care and treatment arms, respectively (P = 0.001). Overall survival did not significantly differ between the two groups (HR, 0.85, 95% CI 0.66 to 1.08), with median survival 13.3 months with standard therapy versus 16.6 months with bevacizumab. PFS was 3.4 months in the standard care arm and 6.7 months with bevacizumab (P < 0.001) and increased among all subgroups, including the group with ascites.

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