Abstract
As increased angiogenesis has been linked with the progression of ovarian cancer, a number of anti-angiogenic agents have been investigated, or are currently in development, as potential treatment options for patients with advanced disease. Bevacizumab, a recombinant monoclonal antibody against vascular endothelial growth factor, has gained European Medicines Agency approval for the front-line treatment of advanced epithelial ovarian cancer, fallopian tube cancer or primary peritoneal cancer in combination with carboplatin and paclitaxel, and for the treatment of first recurrence of platinum-sensitive ovarian cancer in combination with carboplatin and gemcitabine. We conducted a systematic literature review to identify available efficacy and safety data for bevacizumab in ovarian cancer as well as for newer anti-angiogenic agents in development. We analyzed published data from randomized, controlled phase II/III clinical trials enrolling women with ovarian cancer to receive treatment with bevacizumab. We also reviewed available data for emerging anti-angiogenic agents currently in phase II/III development, including trebananib, aflibercept, nintedanib, cediranib, imatinib, pazopanib, sorafenib and sunitinib. Significant efficacy gains were achieved with the addition of bevacizumab to standard chemotherapy in four randomized, double-blind, phase III trials, both as front-line treatment (GOG-0218 and ICON7) and in patients with recurrent disease (OCEANS and AURELIA). The type and frequency of bevacizumab-related adverse events was as expected in these studies based on published data. Promising efficacy data have been published for a number of emerging anti-angiogenic agents in phase III development for advanced ovarian cancer. Further research is needed to identify predictive or prognostic markers of response to bevacizumab in order to optimize patient selection and treatment benefit. Data from phase III trials of newer anti-angiogenic agents in ovarian cancer are awaited.
Highlights
Ovarian cancer is the seventh most common cancer in women [1], with an estimated 225,500 new cases and 140,200 deaths globally in 2008 [2]
A modified CP regimen with weekly paclitaxel resulted in better long-term outcome than the 3-weekly regimen in a phase III study in Japanese women with advanced ovarian cancer [7,8], with confirmatory findings reported in European women in the randomized, multicenter phase III MITO-7 study [9], and in the chemotherapy arm of the phase III GOG-0262 trial [10]
Bevacizumab has demonstrated significant efficacy benefits in four randomized, double-blind, phase III studies in combination with standard chemotherapy for advanced ovarian cancer, both as front-line treatment and in patients with recurrent disease. These findings were confirmed in a meta-analysis of these four studies, which concluded that the addition of bevacizumab to chemotherapy offers meaningful improvement in Progression-free survival (PFS) and objective response rate (ORR) in ovarian cancer treatment [70]
Summary
Ovarian cancer is the seventh most common cancer in women [1], with an estimated 225,500 new cases and 140,200 deaths globally in 2008 [2]. Data from a randomized, double-blind, phase III trial in 940 women with advanced ovarian cancer who had not progressed after front-line chemotherapy showed a statistically significant PFS benefit for patients receiving pazopanib versus placebo (HR 0.766, 95% CI: 0.64–0.91; p = 0.0021) (Table 3) [44]. GI symptoms, hand-foot syndrome and hypertension were the most frequently occurring AEs. More recently, a phase II trial compared continuous and intermittent dosing of sunitinib in 73 women with platinum-resistant ovarian cancer, who had received ≤ 3 prior chemotherapy regimens, and concluded that the intermittent schedule showed greatest activity and should be further evaluated in this setting (Table 3) [47]. The type and incidence of AEs between the treatment groups was similar, and included fatigue, cardiovascular, GI and abdominal symptoms
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