TKI Hikes Survival in Recurrent Ovarian Cancer
Turning now to the other end of the spectrum -- patients with platinum-resistant ovarian cancer -- the question addressed in the AURELIA study (that originally was presented by Eric Pujade-Lauraine) was whether bevacizumab added to single-agent chemotherapy (which was the standard of care in that context) -- weekly paclitaxel, doxorubicin, or topotecan -- would improve survival. At this meeting we saw the overall survival data that we have been patiently waiting for. This was a much smaller study (a total of 361 patients), and they were divided into 3 subgroups according to which chemotherapy was given. The study randomly assigned patients to receive single-agent chemotherapy alone or with bevacizumab. The bottom line was that there was no difference in the overall study between the groups with or without bevacizumab, although there were clearly progression-free survival differences in the initial presentation. The explanation, we assume (and it probably is correct), is that there was a planned crossover so that patients who had not received bevacizumab initially could receive bevacizumab at relapse.
We know now that there isn't an overall survival benefit, but it was interesting that when they looked at the 3 subgroups according to the chemotherapy given, there was a highly significant overall survival benefit in the weekly paclitaxel group. The median survival for weekly paclitaxel alone was approximately 13 months. When bevacizumab was added to that, even though bevacizumab could have been allowed in the crossover, the median survival was 22 months. There is something here that we don't understand, although it is obviously important to try to understand the mechanisms that underlie this finding. In the planned subgroup analysis, bevacizumab added to the overall survival benefit of weekly paclitaxel in platinum-resistant disease. These are small numbers of patients, probably 130 or 140 patients overall. Nevertheless, this is an interesting and provocative finding that indicates that in patients who have not had bevacizumab before, this would reinforces the notion that in platinum-resistant disease, bevacizumab is entirely appropriate to add to chemotherapy.
Surprise Benefit From Bevacizumab and Paclitaxel
Turning now to the other end of the spectrum -- patients with platinum-resistant ovarian cancer -- the question addressed in the AURELIA study (that originally was presented by Eric Pujade-Lauraine) was whether bevacizumab added to single-agent chemotherapy (which was the standard of care in that context) -- weekly paclitaxel, doxorubicin, or topotecan -- would improve survival. At this meeting we saw the overall survival data that we have been patiently waiting for. This was a much smaller study (a total of 361 patients), and they were divided into 3 subgroups according to which chemotherapy was given. The study randomly assigned patients to receive single-agent chemotherapy alone or with bevacizumab. The bottom line was that there was no difference in the overall study between the groups with or without bevacizumab, although there were clearly progression-free survival differences in the initial presentation. The explanation, we assume (and it probably is correct), is that there was a planned crossover so that patients who had not received bevacizumab initially could receive bevacizumab at relapse.
We know now that there isn't an overall survival benefit, but it was interesting that when they looked at the 3 subgroups according to the chemotherapy given, there was a highly significant overall survival benefit in the weekly paclitaxel group. The median survival for weekly paclitaxel alone was approximately 13 months. When bevacizumab was added to that, even though bevacizumab could have been allowed in the crossover, the median survival was 22 months. There is something here that we don't understand, although it is obviously important to try to understand the mechanisms that underlie this finding. In the planned subgroup analysis, bevacizumab added to the overall survival benefit of weekly paclitaxel in platinum-resistant disease. These are small numbers of patients, probably 130 or 140 patients overall. Nevertheless, this is an interesting and provocative finding that indicates that in patients who have not had bevacizumab before, this would reinforces the notion that in platinum-resistant disease, bevacizumab is entirely appropriate to add to chemotherapy.
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