TKI Hikes Survival in Recurrent Ovarian Cancer

Stanley B. Kaye, MD


October 04, 2013

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Hello. My name is Stanley Kaye, Professor of Medical Oncology at the Institute of Cancer Research and the Royal Marsden Hospital in London, England. Welcome to this edition of Medscape Oncology Insights on ovarian cancer. Today I want to highlight some exciting presentations in ovarian cancer from the 2013 European Cancer Congress in Amsterdam. I want to mainly cover data on angiogenesis inhibitors and poly-ADP-ribose-polymerase (PARP) inhibitors.

ICON7 Overall Survival Confirmed

At this meeting we saw the mature survival data from ICON7, which confirmed information that we previously had. ICON7[1] randomly assigned patients with first-line chemotherapy (carboplatin and paclitaxel) to bevacizumab, given at a dose of 7.5 mg/kg with chemotherapy and up to 12 months later. We heard at previous meetings that there was a benefit in progression-free survival but no overall survival benefit in the first analysis.[2] However, an interim analysis of a planned subgroup of high-risk patients showed an overall survival benefit. We were waiting to hear at this meeting whether this was confirmed in the mature analysis.

With 714 of 1528 study participants having died (352 control, 362 bevacizumab), there was no overall survival benefit between the 2 arms of the trial. That was not unexpected. We wanted to know the overall survival in the planned subgroup of patients with suboptimal surgery (more than 1 cm of residual disease) or stage IV disease. We heard that there was a significant difference in survival. The analyses are done now, probably most accurately with a restricted means analysis, because there is nonproportionality between the curves. The bevacizumab group had a significant improvement in overall survival: 39 months compared with 35 months for the control arm -- a clinically significant benefit. For many people, this indicates that if you want to choose which patients with ovarian cancer should receive bevacizumab as first-line therapy, it would be this suboptimal high-risk group of patients, but not others in whom there was no evidence of a survival benefit.


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