NE Oncology Issue – September 2011

Ovarian Cancer

Among ovarian cancers, surgery to remove as much of the tumour as possible is a mainstay of treatment but unfortunately, the majority of patients are diagnosed with advanced disease and require further treatment.

Bevacizumab, initially approved in 2004 in Canada for advanced colorectal cancer, became the first antiangiogenic therapy made widely available for the treatment of several tumour types, including those of the ovaries. Since its approval for the treatment of ovarian cancer, bevacizumab is increasingly being recognized as a promising new therapy, through its targeted actions on vascular endothelial growth factor.

Several previous pivotal phase III randomized trials have demonstrated progression-free survival (PFS) benefit with bevacizumab in patients with previously untreated (including advanced) epithelial ovarian cancer (EOC), primary peritoneal (PPC), or fallopian tube cancer (FTC).1,2

At ASCO 2011, investigators presented data from studies examining the use of bevacizumab in newly diagnosed, advanced, as well as platinum-sensitive recurrent EOC, PPC, or FTC. These trials add further evidence to support the potential of bevacizumab to improve outcomes in a disease for which there have been few treatment advances in over a decade.

This article reports on three such studies:

  • The OCEANS study — a randomized, double-blind, placebo-controlled, phase III trial of chemotherapy with or without bevacizumab in patients with platinum-sensitive recurrent EOC, PPC, or FTC showed that bevacizumab halved the risk of progression in this setting.
  • An interim analysis of overall survival (OS) in the Gynecologic Cancer Inter Group (GCIG) ICON7 phase III randomized trial of bevacizumab in women with newly diagnosed ovarian cancer showed that the addition of bevacizumab to standard chemotherapy demonstrated continued improvement in PFS, and a trend for improved OS, particularly for patients with more aggressive disease.
  • Independent radiologic review of GOG218 — a phase III trial of bevacizumab in the primary treatment of advanced EOC, PPC, or FTC — confirmed a significant increase in PFS and suggests that response evaluation criteria in solid tumours (RECIST) can be applied objectively in primary ovarian cancers.

References: 1. Burger RA, Brady MF, Bookmanet MA et al. Phase III trial of bevacizumab (BEV) in the primary treatment of advanced epithelial ovarian cancer (EOC), primary peritoneal (PPC) or Fallopian tube cancer (FTC): A Gynaecologic Oncology Group study. J Clin Oncol 2010;28:946s (Abstract LBA1). 2. Perren T, Swart AM, Pfistere J, et al. ICON7: A phase III Randomised Gynaecologic Cancer InterGroup (GCIG) trial of concurrent bevacizumab and chemotherapy followed by maintenance bevacizumab in women with newly diagnosed epithelial ovarian (EOC), primary peritoneal (PPC) or fallopian tube cancer (FTC). ESMO 2010 (Abstract LBA4).

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Canadian Perspectives

Silvy Lachance, MD, FRCPC, CSPQ
Dr. Silvy Lachance is currently a hematologist, clinical researcher, and Director of the Stem Cell Transplant Program at the MaisonneuveRosement Hospital in Montreal, Quebec, and Professor of Medicine and Director of the Fellowship Program in Stem Cell Transplantation at the University of Montreal. In 1995, Dr. Lachance established the first Stem Cell Transplant Unit at the University Health Centre (CUSE) in Sherbrooke, Quebec. She joined the Hematology and Oncology Division of the Montreal General Hospital as a transplant physician in 1997 and became an Associate Professor of Medicine at McGill University in 2005, holding both positions until 2006. Dr. Lachance has served as chair of the Continuing Medical Education Committee of the Quebec Association of Hematologists and Oncologists, and is currently treasurer of the executive committee. She has also served as chair of the jury for the hematology specialty exam board of the Collège des Médecins du Québec (CMQ). Her research interests include stem cell transplant, graft-versus-host-disease, and lymphoproliferative disorders.

Teresa Petrella, BSc, MD, MSc, FRCPC
Teresa Petrella is a Medical Oncologist at the Odette Cancer Centre (OCC) in Toronto, Canada and an Assistant Professor at the University of Toronto. Dr. Petrella has a BSc in Molecular Biology from the University of Western Ontario and she completed her MD at Queen’s University. Her Internal Medicine and Medical Oncology training was at McMaster University. She subsequently completed a fellowship in Melanoma and Breast Cancer at the Toronto Sunnybrook Regional Cancer Centre along with a Masters degree in Health Research Methodology at McMaster University. She was the recipient of a CIHR/CAMO award for her research in vaccine therapy in combination with interferon for melanoma patients. Dr. Petrella joined the staff at OCC in 2002 and became the head of the Melanoma Site Group. She also chairs the Provincial Guidelines Melanoma Disease Site Group Program in Evidence Based Care the National Cancer Institute of Canada (NCIC) Melanoma Clinical Trials Group. Her research interests are in melanoma and breast cancer and she is currently the Principal Investigator for several multicentre trials investigating novel therapies in melanoma.