Having more frequent chemotherapy and bevacizumab treats advanced ovarian cancer more effectively
02 Oct 2023
Results from the ICON8B trial show that, for women with high-risk advanced ovarian cancer, combined chemotherapy and bevacizumab treatment is better at preventing the cancer coming back or getting worse when chemotherapy is given weekly rather than every three weeks. These results were presented last weekend at the European Gynaecological Oncology Congress (ESGO) in Istanbul, Turkey.
In the UK, ovarian cancer is the sixth most common cancer in women. The standard treatment for ovarian cancer includes a combination of surgery and chemotherapy. Surgery removes as much of the cancer as possible, whilst chemotherapy aims to kill any remaining cancer cells, reducing the chances of the cancer coming back. Surgery can be given before starting chemotherapy or after having received a few doses of chemotherapy.
Standard chemotherapy for ovarian cancer consists of two drugs, carboplatin and paclitaxel. They are given once every three weeks (called a “cycle”) and patients can receive up to 6 cycles over the course of approximately 6 months.
Anti-angiogenic drugs aim to stop the cancer from growing its own blood vessels, interfering with its ability to grow and spread to other parts of the body. Bevacizumab is an anti-angiogenic drug commonly used to treat high-risk ovarian cancer. It is given once every three weeks, in combination with the standard chemotherapy.
The ICON8B trial looked at two ways of giving chemotherapy combined with bevacizumab to treat high-risk, advanced ovarian cancer. Women who were diagnosed with stage III or IV epithelial ovarian cancer, fallopian tube cancer or primary peritoneal cancer could take part in the trial.
579 women took part, and they were allocated at random to a treatment group:
- Standard chemotherapy and bevacizumab. Carboplatin and paclitaxel were given once every three weeks together with bevacizumab for up to 6 cycles (chemotherapy phase). Bevacizumab then continued to be given every 3 weeks for up to 42 weeks after enrolment (maintenance phase).
- Weekly chemotherapy and bevacizumab. The chemotherapy drug paclitaxel was given once a week (at a lower dose), while carboplatin and bevacizumab were given every 3 weeks for up to 6 cycles, as in the standard chemotherapy group (chemotherapy phase). Bevacizumab then continued to be given every 3 weeks for up to 42 weeks after enrolment (maintenance phase).
In both groups, patients could have surgery either before starting chemotherapy or after they had received three cycles of chemotherapy.
After following up the participants for an average of five years, the results showed that combining bevacizumab with weekly chemotherapy is more effective at preventing ovarian cancer coming back than standard chemotherapy with bevacizumab. On average, it took five and a half months longer for the cancer to come back or worsen in women who had weekly chemotherapy with bevacizumab, compared with women who had standard chemotherapy with bevacizumab.
Preliminary analysis also suggests that women having weekly chemotherapy live about 10 months longer than those receiving the standard chemotherapy.
Side effects from chemotherapy were common. The main difference between groups was that women who had weekly chemotherapy and bevacizumab were more likely to have anemia and hypertension than women in the standard chemotherapy and bevacizumab group.
These results showed that weekly chemotherapy in combination with bevacizumab benefits women with ovarian cancer, and should be considered a standard of care option for patients with high-risk, advanced ovarian cancer. The researchers are continuing to follow up these women and plan to carry out quality-of-life studies and economic analysis to understand the cost-effectiveness of more frequent chemotherapy with bevacizumab.
The ICON8B was designed and run by the MRC Clinical Trials Unit at UCL. The trial was led by Dr Andrew Clamp, a consultant medical oncologist based at The Christie NHS Foundation Trust, and funded by Cancer Research UK.
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