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Gaitskell K, Rogozińska E, Platt S, Chen Y, Abd El Aziz M, Tattersall A, Morrison J. Angiogenesis inhibitors for the treatment of epithelial ovarian cancer. Cochrane Database Syst Rev 2023; 4:CD007930. [PMID: 37185961 PMCID: PMC10111509 DOI: 10.1002/14651858.cd007930.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
BACKGROUND Many women, and other females, with epithelial ovarian cancer (EOC) develop resistance to conventional chemotherapy drugs. Drugs that inhibit angiogenesis (development of new blood vessels), essential for tumour growth, control cancer growth by denying blood supply to tumour nodules. OBJECTIVES To compare the effectiveness and toxicities of angiogenesis inhibitors for treatment of epithelial ovarian cancer (EOC). SEARCH METHODS We identified randomised controlled trials (RCTs) by searching CENTRAL, MEDLINE and Embase (from 1990 to 30 September 2022). We searched clinical trials registers and contacted investigators of completed and ongoing trials for further information. SELECTION CRITERIA RCTs comparing angiogenesis inhibitors with standard chemotherapy, other types of anti-cancer treatment, other angiogenesis inhibitors with or without other treatments, or placebo/no treatment in a maintenance setting, in women with EOC. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. Our outcomes were overall survival (OS), progression-free survival (PFS), quality of life (QoL), adverse events (grade 3 and above) and hypertension (grade 2 and above). MAIN RESULTS We identified 50 studies (14,836 participants) for inclusion (including five studies from the previous version of this review): 13 solely in females with newly-diagnosed EOC and 37 in females with recurrent EOC (nine studies in platinum-sensitive EOC; 19 in platinum-resistant EOC; nine with studies with mixed or unclear platinum sensitivity). The main results are presented below. Newly-diagnosed EOC Bevacizumab, a monoclonal antibody that binds vascular endothelial growth factor (VEGF), given with chemotherapy and continued as maintenance, likely results in little to no difference in OS compared to chemotherapy alone (hazard ratio (HR) 0.97, 95% confidence interval (CI) 0.88 to 1.07; 2 studies, 2776 participants; moderate-certainty evidence). Evidence is very uncertain for PFS (HR 0.82, 95% CI 0.64 to 1.05; 2 studies, 2746 participants; very low-certainty evidence), although the combination results in a slight reduction in global QoL (mean difference (MD) -6.4, 95% CI -8.86 to -3.94; 1 study, 890 participants; high-certainty evidence). The combination likely increases any adverse event (grade ≥ 3) (risk ratio (RR) 1.16, 95% CI 1.07 to 1.26; 1 study, 1485 participants; moderate-certainty evidence) and may result in a large increase in hypertension (grade ≥ 2) (RR 4.27, 95% CI 3.25 to 5.60; 2 studies, 2707 participants; low-certainty evidence). Tyrosine kinase inhibitors (TKIs) to block VEGF receptors (VEGF-R), given with chemotherapy and continued as maintenance, likely result in little to no difference in OS (HR 0.99, 95% CI 0.84 to 1.17; 2 studies, 1451 participants; moderate-certainty evidence) and likely increase PFS slightly (HR 0.88, 95% CI 0.77 to 1.00; 2 studies, 2466 participants; moderate-certainty evidence). The combination likely reduces QoL slightly (MD -1.86, 95% CI -3.46 to -0.26; 1 study, 1340 participants; moderate-certainty evidence), but it increases any adverse event (grade ≥ 3) slightly (RR 1.31, 95% CI 1.11 to 1.55; 1 study, 188 participants; moderate-certainty evidence) and may result in a large increase in hypertension (grade ≥ 3) (RR 6.49, 95% CI 2.02 to 20.87; 1 study, 1352 participants; low-certainty evidence). Recurrent EOC (platinum-sensitive) Moderate-certainty evidence from three studies (with 1564 participants) indicates that bevacizumab with chemotherapy, and continued as maintenance, likely results in little to no difference in OS (HR 0.90, 95% CI 0.79 to 1.02), but likely improves PFS (HR 0.56, 95% CI 0.50 to 0.63) compared to chemotherapy alone. The combination may result in little to no difference in QoL (MD 0.8, 95% CI -2.11 to 3.71; 1 study, 486 participants; low-certainty evidence), but it increases the rate of any adverse event (grade ≥ 3) slightly (RR 1.11, 1.07 to 1.16; 3 studies, 1538 participants; high-certainty evidence). Hypertension (grade ≥ 3) was more common in arms with bevacizumab (RR 5.82, 95% CI 3.84 to 8.83; 3 studies, 1538 participants). TKIs with chemotherapy may result in little to no difference in OS (HR 0.86, 95% CI 0.67 to 1.11; 1 study, 282 participants; low-certainty evidence), likely increase PFS (HR 0.56, 95% CI 0.44 to 0.72; 1 study, 282 participants; moderate-certainty evidence), and may have little to no effect on QoL (MD 6.1, 95% CI -0.96 to 13.16; 1 study, 146 participants; low-certainty evidence). Hypertension (grade ≥ 3) was more common with TKIs (RR 3.32, 95% CI 1.21 to 9.10). Recurrent EOC (platinum-resistant) Bevacizumab with chemotherapy and continued as maintenance increases OS (HR 0.73, 95% CI 0.61 to 0.88; 5 studies, 778 participants; high-certainty evidence) and likely results in a large increase in PFS (HR 0.49, 95% CI 0.42 to 0.58; 5 studies, 778 participants; moderate-certainty evidence). The combination may result in a large increase in hypertension (grade ≥ 2) (RR 3.11, 95% CI 1.83 to 5.27; 2 studies, 436 participants; low-certainty evidence). The rate of bowel fistula/perforation (grade ≥ 2) may be slightly higher with bevacizumab (RR 6.89, 95% CI 0.86 to 55.09; 2 studies, 436 participants). Evidence from eight studies suggest TKIs with chemotherapy likely result in little to no difference in OS (HR 0.85, 95% CI 0.68 to 1.08; 940 participants; moderate-certainty evidence), with low-certainty evidence that it may increase PFS (HR 0.70, 95% CI 0.55 to 0.89; 940 participants), and may result in little to no meaningful difference in QoL (MD ranged from -0.19 at 6 weeks to -3.40 at 4 months). The combination increases any adverse event (grade ≥ 3) slightly (RR 1.23, 95% CI 1.02 to 1.49; 3 studies, 402 participants; high-certainty evidence). The effect on bowel fistula/perforation rates is uncertain (RR 2.74, 95% CI 0.77 to 9.75; 5 studies, 557 participants; very low-certainty evidence). AUTHORS' CONCLUSIONS Bevacizumab likely improves both OS and PFS in platinum-resistant relapsed EOC. In platinum-sensitive relapsed disease, bevacizumab and TKIs probably improve PFS, but may or may not improve OS. The results for TKIs in platinum-resistant relapsed EOC are similar. The effects on OS or PFS in newly-diagnosed EOC are less certain, with a decrease in QoL and increase in adverse events. Overall adverse events and QoL data were more variably reported than were PFS data. There appears to be a role for anti-angiogenesis treatment, but given the additional treatment burden and economic costs of maintenance treatments, benefits and risks of anti-angiogenesis treatments should be carefully considered.
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Affiliation(s)
- Kezia Gaitskell
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | - Sarah Platt
- Obstetrics and Gynaecology, St Mary's Hospital, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Department of Gynaecological Oncology, St. Michael's Hospital, Bristol, UK
| | - Yifan Chen
- Oxford Medical School, University of Oxford, Oxford, UK
| | | | | | - Jo Morrison
- Department of Gynaecological Oncology, Musgrove Park Hospital, Somerset NHS Foundation Trust, Taunton, UK
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Pfisterer J, Rau J. Reply to R. Sun et al. J Clin Oncol 2023; 41:1953-1954. [PMID: 36763928 DOI: 10.1200/jco.23.00063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 01/12/2023] [Indexed: 02/12/2023] Open
Affiliation(s)
- Jacobus Pfisterer
- Jacobus Pfisterer, MD, Arbeitsgemeinschaft Gynaekologische Onkologie (AGO) Study Group and Gynecologic Oncology Center, Kiel, Germany; and Joern Rau, MSc, AGO Study Group and Coordinating Center for Clinical Trials, Philipps-University Marburg, Marburg, Germany
| | - Joern Rau
- Jacobus Pfisterer, MD, Arbeitsgemeinschaft Gynaekologische Onkologie (AGO) Study Group and Gynecologic Oncology Center, Kiel, Germany; and Joern Rau, MSc, AGO Study Group and Coordinating Center for Clinical Trials, Philipps-University Marburg, Marburg, Germany
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Lorusso D, Guy H, Samyshkin Y, Hawkes C, Estenson K, Coleman RL. Feasibility Study of a Network Meta-Analysis and Unanchored Population-Adjusted Indirect Treatment Comparison of Niraparib, Olaparib, and Bevacizumab as Maintenance Therapies in Patients with Newly Diagnosed Advanced Ovarian Cancer. Cancers (Basel) 2022; 14:1285. [PMID: 35267593 PMCID: PMC8909094 DOI: 10.3390/cancers14051285] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 02/22/2022] [Accepted: 02/23/2022] [Indexed: 01/27/2023] Open
Abstract
Selecting a first-line (1L) maintenance option for ovarian cancer is challenging given the variety of therapies, differing trials, and the lack of head-to-head data for angiogenesis and poly(ADP-ribose) polymerase (PARP) inhibitors. Thus, indirect treatment comparisons (ITCs) can aid treatment decision making. This study assessed the feasibility of two ITCs, a network meta-analysis (NMA) and a population-adjusted ITC (PAIC), comparing the efficacy of the PARP inhibitor niraparib in the PRIMA trial (NCT02655016) with other 1L maintenance treatments. A systematic literature review was conducted to identify trials using the Cochrane Handbook for Systematic Reviews of Interventions to assess differences in trial design, population characteristics, treatment arms, and outcome measures. All 12 trials identified were excluded from the NMA due to the absence of a common comparator and differences in survival measures and/or inclusion criteria. The PAIC comparing PRIMA and PAOLA-1 trials was also not feasible due to differences in inclusion criteria, survival measures, and the previous receipt of chemotherapy/bevacizumab. Neither ITC met recommended guidelines for analysis; the results of such comparisons would not be considered appropriate evidence when selecting 1L maintenance options in ovarian cancer. ITCs in this setting should be performed cautiously, as many factors can preclude objective trial comparisons.
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Affiliation(s)
- Domenica Lorusso
- Fondazione Policlinico Gemelli of Rome, 00168 Rome, Italy
- Department of Gynecologic Oncology, Catholic University of Sacred Heart, 00168 Rome, Italy
| | | | | | - Carol Hawkes
- GlaxoSmithKline, Brentford TW8 9GS, UK; (Y.S.); (C.H.)
| | - Kasey Estenson
- GlaxoSmithKline, Philadelphia, PA 19112, USA;
- Eisai Inc., Nutley, NJ 07677, USA
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Patterns of use and outcomes of adjuvant bevacizumab therapy prior to regulatory approval in women with newly diagnosed ovarian cancer. Arch Gynecol Obstet 2022; 305:1647-1654. [PMID: 34993579 DOI: 10.1007/s00404-021-06282-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 10/11/2021] [Indexed: 11/02/2022]
Abstract
PURPOSE We used real-world claims data to assess the utility of the relatively novel therapeutic bevacizumab in patients with newly diagnosed ovarian cancer in the United States after release of clinical data but prior to FDA approval. METHODS We used the IQVIA Pharmetrics Plus commercial claims database to identify women with a new diagnosis of ovarian cancer who underwent primary surgery or neoadjuvant chemotherapy followed by interval surgery from 2006 to 2018. We calculated the rate of use of bevacizumab, and the relative frequency of hospital and emergency department (ED) admissions. Treatment-related toxicities, and time to second line chemotherapy were calculated. RESULTS Among 8923 women who met study parameters, 533 (6.0%) received bevacizumab. The rate of use increased over time from 1.5% in 2006 to 7.0% in 2017 (P < 0.001), with a peak of 8.6% in 2011. The use was lowest in those ≥ 70 years old (2.8%), and in the West (4.5%), and was unaffected by number of comorbidities. Over one third (35.1%) received bevacizumab for less than 3 months, and 15.9% remained on it for greater than 13 months. Bevacizumab use was not associated with hospitalization or ED admission. Toxicities included hypertension (15.0%), kidney damage (6.8%), bleeding (3.8%), venous thrombo-embolism (2.3%) and fistula (1.1%). Time from initiation of first line chemotherapy to initiation of second line therapy was 19.9 months without bevacizumab and 22.6 months with bevacizumab use. CONCLUSIONS Real-world patterns of upfront bevacizumab use prior to FDA approval in 2018 differed significantly from trial data.
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Progression-free survival by investigator versus blinded independent central review in newly diagnosed patients with high-grade serous ovarian cancer: Analysis of the VELIA/GOG-3005 trial. Gynecol Oncol 2021; 162:375-381. [PMID: 34112513 DOI: 10.1016/j.ygyno.2021.05.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 05/26/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE In the phase 3 VELIA/GOG-3005 trial, veliparib added to carboplatin-paclitaxel and continued as maintenance improved progression-free survival (PFS) compared to carboplatin-paclitaxel alone in patients with newly diagnosed ovarian carcinoma. Primary analysis of PFS was by investigator (INV) assessment, with a supplemental analysis of PFS by blinded independent central review (BICR). METHODS Patients received veliparib or placebo with carboplatin-paclitaxel (6 cycles) and as maintenance (30 additional cycles). The primary analysis compared PFS in the veliparib-throughout arm to the carboplatin-paclitaxel only arm in the BRCA mutation (BRCAm), homologous recombination deficiency (HRD), and intention-to-treat (ITT) populations. Exploratory analyses of PFS in BRCA wildtype (BRCAwt), homologous recombination proficient (HRP), and HRD + BRCAwt populations were also performed. PFS per BICR and overall concordance rates between INV and BICR assessments were analyzed. RESULTS Hazard ratios for PFS by INV and BICR were consistent in each of the primary analysis and exploratory populations. In the ITT population, median PFS per INV was 23.5 months in the veliparib-throughout arm versus 17.3 months in the control arm (hazard ratio [HR] 0.683, 95% confidence interval [CI] 0.562-0.831; P < 0.001). Median PFS by BICR was 29.3 months versus 19.2 months (HR 0.687, 95% CI 0.504-0.806). In the ITT population, the overall concordance rates between INV and BICR were 78% and 75% for the veliparib-throughout and control arms, respectively. CONCLUSIONS Hazard ratios for PFS per BICR and per INV were consistent, with no suggestion of investigator bias. These findings support the reliability of PFS by INV in ovarian cancer trials.
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Chikazawa K, Netsu S, Imai K, Ishiguro A, Kimura A, Wang L, Kuwata T, Konno R. Nedaplatin use in patients with hypersensitivity reaction episodes to carboplatin. Taiwan J Obstet Gynecol 2021; 59:546-550. [PMID: 32653127 DOI: 10.1016/j.tjog.2020.05.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2020] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE To evaluate the benefits of nedaplatin treatment in patients with a history of hypersensitivity reactions to carboplatin. MATERIALS AND METHODS We retrospectively reviewed the medical records of patients with ovarian, fallopian, and peritoneal cancers and with a history of hypersensitivity to carboplatin between January 2010 and December 2016 at the Department of Gynecology in the Saitama Medical Center associated with Jichi Medical University. We studied the response rate to treatment with a nedaplatin-based regimen compared to that of a carboplatin regimen. Fisher's exact test was used to determine statistical significance. RESULTS Thirty-one patients with a past hypersensitivity to carboplatin were treated with nedaplatin-based regimen, while ten patients were treated with other drugs. The response rates in the nedaplatin- and non-nedaplatin-treated patient groups were 71.4% and 30.0%, respectively (P = 0.021). Among all the patients, only one experienced hypersensitivity reaction to nedaplatin. CONCLUSION The nedaplatin regimen following hypersensitivity to carboplatin was safe, feasible, and effective in achieving complete or partial response.
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Affiliation(s)
- Kenro Chikazawa
- Department of Obstetrics and Gynecology, Jichi Medical University, Saitama Medical Center, Japan.
| | - Sachiho Netsu
- Department of Gynecology, Cancer Institute Hospital, Tokyo, Japan
| | - Ken Imai
- Department of Obstetrics and Gynecology, Jichi Medical University, Saitama Medical Center, Japan
| | - Aya Ishiguro
- Department of Obstetrics and Gynecology, Jichi Medical University, Saitama Medical Center, Japan
| | - Azusa Kimura
- Department of Obstetrics and Gynecology, Jichi Medical University, Saitama Medical Center, Japan
| | - Liangcheng Wang
- Department of Obstetrics and Gynecology, Jichi Medical University, Saitama Medical Center, Japan
| | - Tomoyuki Kuwata
- Department of Obstetrics and Gynecology, Jichi Medical University, Saitama Medical Center, Japan
| | - Ryo Konno
- Department of Obstetrics and Gynecology, Jichi Medical University, Saitama Medical Center, Japan
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Loreen A, Polen-De C, Monk BJ, Jackson AL, Billingsley CC, Herzog TJ. The role of blinded independent radiologic review in ovarian cancer clinical trials: Discerning the value. Gynecol Oncol 2021; 161:491-495. [PMID: 33722416 DOI: 10.1016/j.ygyno.2021.02.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 02/21/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Amy Loreen
- University of Cincinnati Medical Center, 234 Goodman St, Cincinnati, OH 45219, United States of America
| | - Clarissa Polen-De
- University of Cincinnati Medical Center, 234 Goodman St, Cincinnati, OH 45219, United States of America
| | - Bradley J Monk
- Biltmore Cancer Center, 2222 E Highland Ave #400, Phoenix, AR 85016, United States of America
| | - Amanda L Jackson
- University of Cincinnati Medical Center, 234 Goodman St, Cincinnati, OH 45219, United States of America
| | - Caroline C Billingsley
- University of Cincinnati Medical Center, 234 Goodman St, Cincinnati, OH 45219, United States of America
| | - Thomas J Herzog
- University of Cincinnati Medical Center, 234 Goodman St, Cincinnati, OH 45219, United States of America.
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Gabriel EM, Kim M, Fisher DT, Mangum C, Attwood K, Ji W, Mukhopadhyay D, Bagaria SP, Robertson MW, Dinh TA, Knutson KL, Skitzki JJ, Wallace MB. A pilot trial of intravital microscopy in the study of the tumor vasculature of patients with peritoneal carcinomatosis. Sci Rep 2021; 11:4946. [PMID: 33654117 PMCID: PMC7925603 DOI: 10.1038/s41598-021-84430-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 02/16/2021] [Indexed: 01/31/2023] Open
Abstract
Aberrancies in the tumor microvasculature limit the systemic delivery of anticancer agents, which impedes tumor response. Using human intravital microscopy (HIVM), we hypothesized that HIVM would be feasible in patients with peritoneal carcinomatosis (PC). During cytoreductive surgery with hyperthermic intraperitoneal chemotherapy for PC, HIVM was performed in both tumor and non-tumor areas. The primary outcome was HIVM feasibility to measure vessel characteristics. We secondarily evaluated associations between HIVM vessel characteristics and oncologic outcomes (RECIST response to neoadjuvant therapy and disease-specific survival). Thirty patients with PC were enrolled. Nineteen patients (63.3%) received neoadjuvant therapy. HIVM was feasible in all patients. Compared to non-tumor (control) areas, PC areas had a lower density of functional vessels, higher proportion of non-functional vessels, smaller lumenal diameters, and lower blood flow velocity. Qualitative differences in these vessel characteristics were observed among patients who had partial response, stable disease, or progressive disease after receiving neoadjuvant therapy. However, no statistically significant relationships were found between HIVM vessel characteristics and oncologic outcomes. These novel findings comprise the first-in-human, real-time evidence of the microscopic differences between normal and tumor-associated vessels and form the basis for our larger, ongoing clinical trial appropriately powered to determine the clinical utility of HIVM (NCT03823144).
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Affiliation(s)
- Emmanuel M. Gabriel
- grid.417467.70000 0004 0443 9942Department of Surgery, Section of Surgical Oncology, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL 32224 USA
| | - Minhyung Kim
- grid.240614.50000 0001 2181 8635Department of Immunology, Roswell Park Comprehensive Cancer Center, Buffalo, NY USA
| | - Daniel T. Fisher
- grid.240614.50000 0001 2181 8635Department of Immunology, Roswell Park Comprehensive Cancer Center, Buffalo, NY USA
| | - Catherine Mangum
- grid.417467.70000 0004 0443 9942Department of Surgery, Section of Surgical Oncology, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL 32224 USA
| | - Kristopher Attwood
- grid.240614.50000 0001 2181 8635Department of Biostatistics, Roswell Park Comprehensive Cancer Center, Buffalo, NY USA
| | - Wenyan Ji
- grid.240614.50000 0001 2181 8635Department of Biostatistics, Roswell Park Comprehensive Cancer Center, Buffalo, NY USA
| | - Debabrata Mukhopadhyay
- grid.417467.70000 0004 0443 9942Department of Molecular Biology, Mayo Clinic, Jacksonville, FL USA
| | - Sanjay P. Bagaria
- grid.417467.70000 0004 0443 9942Department of Surgery, Section of Surgical Oncology, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL 32224 USA
| | - Matthew W. Robertson
- grid.417467.70000 0004 0443 9942Department of Gynecological Oncology, Mayo Clinic, Jacksonville, FL USA
| | - Tri A. Dinh
- grid.417467.70000 0004 0443 9942Department of Gynecological Oncology, Mayo Clinic, Jacksonville, FL USA
| | - Keith L. Knutson
- grid.417467.70000 0004 0443 9942Department of Immunology, Mayo Clinic, Jacksonville, FL USA
| | - Joseph J. Skitzki
- grid.240614.50000 0001 2181 8635Department of Surgical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, NY USA
| | - Michael B. Wallace
- grid.417467.70000 0004 0443 9942Department of Gastroenterology, Mayo Clinic, Jacksonville, FL USA
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Winfield JM, Wakefield JC, Brenton JD, AbdulJabbar K, Savio A, Freeman S, Pace E, Lutchman-Singh K, Vroobel KM, Yuan Y, Banerjee S, Porta N, Ahmed Raza SE, deSouza NM. Biomarkers for site-specific response to neoadjuvant chemotherapy in epithelial ovarian cancer: relating MRI changes to tumour cell load and necrosis. Br J Cancer 2021; 124:1130-1137. [PMID: 33398064 PMCID: PMC7961011 DOI: 10.1038/s41416-020-01217-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 11/11/2020] [Accepted: 11/25/2020] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Diffusion-weighted magnetic resonance imaging (DW-MRI) potentially interrogates site-specific response to neoadjuvant chemotherapy (NAC) in epithelial ovarian cancer (EOC). METHODS Participants with newly diagnosed EOC due for platinum-based chemotherapy and interval debulking surgery were recruited prospectively in a multicentre study (n = 47 participants). Apparent diffusion coefficient (ADC) and solid tumour volume (up to 10 lesions per participant) were obtained from DW-MRI before and after NAC (including double-baseline for repeatability assessment in n = 19). Anatomically matched lesions were analysed after surgical excision (65 lesions obtained from 25 participants). A trained algorithm determined tumour cell fraction, percentage tumour and percentage necrosis on histology. Whole-lesion post-NAC ADC and pre/post-NAC ADC changes were compared with histological metrics (residual tumour/necrosis) for each tumour site (ovarian, omental, peritoneal, lymph node). RESULTS Tumour volume reduced at all sites after NAC. ADC increased between pre- and post-NAC measurements. Post-NAC ADC correlated negatively with tumour cell fraction. Pre/post-NAC changes in ADC correlated positively with percentage necrosis. Significant correlations were driven by peritoneal lesions. CONCLUSIONS Following NAC in EOC, the ADC (measured using DW-MRI) increases differentially at disease sites despite similar tumour shrinkage, making its utility site-specific. After NAC, ADC correlates negatively with tumour cell fraction; change in ADC correlates positively with percentage necrosis. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov NCT01505829.
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Affiliation(s)
- Jessica M Winfield
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research, 123 Old Brompton Road, London, SW7 3RP, UK
- MRI Unit, Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK
| | - Jennifer C Wakefield
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research, 123 Old Brompton Road, London, SW7 3RP, UK
- MRI Unit, Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK
| | - James D Brenton
- Cancer Research UK Cambridge Institute, Cambridge, CB2 0RE, UK
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK
- Department of Oncology, University of Cambridge, Cambridge, CB2 0XZ, UK
| | - Khalid AbdulJabbar
- Centre for Evolution and Cancer, The Institute of Cancer Research, London, UK
- Division of Molecular Pathology, The Institute of Cancer Research, London, UK
| | - Antonella Savio
- Department of Pathology, Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK
| | - Susan Freeman
- Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK
| | - Erika Pace
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research, 123 Old Brompton Road, London, SW7 3RP, UK
- MRI Unit, Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK
| | - Kerryn Lutchman-Singh
- Swansea Gynaecological Oncology Centre, Swansea Bay University Health Board, Singleton Hospital, Swansea, SA2 8QA, UK
| | - Katherine M Vroobel
- Department of Pathology, Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK
| | - Yinyin Yuan
- Centre for Evolution and Cancer, The Institute of Cancer Research, London, UK
- Division of Molecular Pathology, The Institute of Cancer Research, London, UK
| | - Susana Banerjee
- Gynaecology Unit, Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK
| | - Nuria Porta
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, 123 Old Brompton Road, London, SW7 3RP, UK
| | - Shan E Ahmed Raza
- Centre for Evolution and Cancer, The Institute of Cancer Research, London, UK
- Division of Molecular Pathology, The Institute of Cancer Research, London, UK
- Department of Computer Science, University of Warwick, Coventry, UK
| | - Nandita M deSouza
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research, 123 Old Brompton Road, London, SW7 3RP, UK.
- MRI Unit, Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK.
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Frontline Management of Epithelial Ovarian Cancer-Combining Clinical Expertise with Community Practice Collaboration and Cutting-Edge Research. J Clin Med 2020; 9:jcm9092830. [PMID: 32882942 PMCID: PMC7565288 DOI: 10.3390/jcm9092830] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 08/27/2020] [Accepted: 08/28/2020] [Indexed: 01/19/2023] Open
Abstract
Epithelial ovarian cancer (EOC) is the most common histology of ovarian cancer defined as epithelial cancer derived from the ovaries, fallopian tubes, or primary peritoneum. It is the fifth most common cause of cancer-related death in women in the United States. Because of a lack of effective screening and non-specific symptoms, EOC is typically diagnosed at an advanced stage (FIGO stage III or IV) and approximately one third of patients have malignant ascites at initial presentation. The treatment of ovarian cancer consists of a combination of cytoreductive surgery and systemic chemotherapy. Despite the advances with new cytotoxic and targeted therapies, the five-year survival rate for all-stage EOC in the United States is 48.6%. Delivery of up-to-date guideline care and multidisciplinary team efforts are important drivers of overall survival. In this paper, we review our frontline management of EOC that relies on a multi-disciplinary approach drawing on clinical expertise and collaboration combined with community practice and cutting edge clinical and translational research. By optimizing partnerships through team medicine and clinical research, we combine our cancer center clinical expertise, community practice partnership, and clinical and translational research to understand the biology of this deadly disease, advance therapy and connect our patients with the optimal treatment that offers the best possible outcomes.
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Haunschild CE, Tewari KS. Bevacizumab use in the frontline, maintenance and recurrent settings for ovarian cancer. Future Oncol 2020; 16:225-246. [PMID: 31746224 PMCID: PMC7036749 DOI: 10.2217/fon-2019-0042] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 07/15/2019] [Indexed: 12/16/2022] Open
Abstract
On 13 June 2018, Genentech, Inc. issued a press release announcing that the US FDA had approved the antiangiogenesis drug, bevacizumab, in combination with chemotherapy for frontline and maintenance therapy for women with newly diagnosed ovarian cancer. Regulatory approval was based on the National Cancer Institute-sponsored Gynecologic Oncology Group (GOG) protocol 0218, the Phase III, randomized, placebo-controlled, double-blind, multi-center and multi-national clinical trial that met its primary end point, progression-free survival. Bevacizumab is now approved in the frontline, platinum-sensitive recurrent and platinum-resistant recurrent settings for epithelial ovarian cancer. This review will address the broad range of clinical trials addressing the efficacy of bevacizumab use in ovarian cancer.
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Affiliation(s)
- Carolyn E Haunschild
- Clinical Instructor, Department of Obstetrics & Gynecology, Research Fellow, Division of Gynecologic Oncology, University of California, 333 City Blvd West, Suite 1400, Orange, CA 92868, USA
| | - Krishnansu S Tewari
- Professor & Division Director, Director, Division of Gynecologic Oncology, University of California, 333 City Blvd, Orange, CA 92868, USA
- Department of Obstetrics & Gynecology, University of California, The City Tower, 333 City Blvd, West – Suite 1400, Orange, CA 92868, USA
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12
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Gao F, Yang C. Anti-VEGF/VEGFR2 Monoclonal Antibodies and their Combinations with PD-1/PD-L1 Inhibitors in Clinic. Curr Cancer Drug Targets 2020; 20:3-18. [PMID: 31729943 DOI: 10.2174/1568009619666191114110359] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 08/29/2019] [Accepted: 09/19/2019] [Indexed: 12/21/2022]
Abstract
The vascular endothelial growth factor (VEGF)/VEGF receptor 2 (VEGFR2) signaling pathway is one of the most important pathways responsible for tumor angiogenesis. Currently, two monoclonal antibodies, anti-VEGF-A antibody Bevacizumab and anti-VEGFR2 antibody Ramucizumab, have been approved for the treatment of solid tumors. At the same time, VEGF/VEGFR2 signaling is involved in the regulation of immune responses. It is reported that the inhibition of this pathway has the capability to promote vascular normalization, increase the intra-tumor infiltration of lymphocytes, and decrease the number and function of inhibitory immune cell phenotypes, including Myeloid-derived suppressor cells (MDSCs), regulatory T cells (Tregs) and M2 macrophages. On this basis, a number of clinical studies have been performed to investigate the therapeutic potential of VEGF/VEGFR2-targeting antibodies plus programmed cell death protein 1 (PD-1)/ programmed cell death ligand 1 (PD-L1) inhibitors in various solid tumor types. In this context, VEGF/VEGFR2- targeting antibodies, Bevacizumab and Ramucizumab are briefly introduced, with a description of the differences between them, and the clinical studies involved in the combination of Bevacizumab/ Ramucizumab and PD-1/PD-L1 inhibitors are summarized. We hope this review article will provide some valuable clues for further clinical studies and usages.
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Affiliation(s)
- Feng Gao
- BuChang (Beijing) Pharmaceutical Co. Ltd, Hongda Industrial Park, Hongda North Road, Beijing 100176, China
| | - Chun Yang
- BuChang (Beijing) Pharmaceutical Co. Ltd, Hongda Industrial Park, Hongda North Road, Beijing 100176, China
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Yang M, Liu X, Zhang C, Liao F, Li Z, Luo X, Sun Y, Chen C. A Study Of Efficacy And Safety With Apatinib Or Apatinib Combined With Chemotherapy In Recurrent/advanced Ovarian Cancer Patients. Cancer Manag Res 2019; 11:8869-8876. [PMID: 31632146 PMCID: PMC6790407 DOI: 10.2147/cmar.s223372] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 09/23/2019] [Indexed: 12/26/2022] Open
Abstract
Objectives Despite recent advances in the treatment of advanced ovarian cancer, drug selection after second-line chemotherapy has not been well studied. In this study, we retrospectively evaluated the effect and safety of apatinib as monotherapy or in combination with chemotherapy for the treatment of advanced ovarian cancer after second-line treatment. Methods We reviewed the medical records of patients from April 2016 to October 2018 with advanced ovarian cancer who received apatinib after failed second-line chemotherapy. Overall survival (OS) and progression-free survival (PFS) were calculated by the Kaplan-Meier method. Response rate (RR) and disease control rate (DCR) were evaluated using radiologic reports according to RECIST 1.1 criteria. Treatment-related adverse events were evaluated based on NCI-CTC version 4.0. Results Study concerned 22 evaluated cases; of them, 13 patients received apatinib combined with chemotherapy and 9 patients received apatinib monotherapy. The median PFS was 8.2 months (9.7 months in combined group and 4.4 months in monotherapy group, P value was 0.21). The median OS was 13.1 months (13.6 months in combined group and 11.6 months in monotherapy group, P value was 0.45). The RR was 20% and DCR was 85% (combined group: RR 33.3%, DCR 100%, monotherapy group: RR 0%, DCR 62.5%). The main side effect was hypertension (9/22), proteinuria (7/22), oral mucositis (5/22), hand and foot syndrome (6/22%), leukopenia (5/22), etc. Conclusion Apatinib showed good efficacy and safety for advanced ovarian cancer patients whether used alone or in combination with chemotherapy. In the meanwhile, this study is limited by the small cases number. Therefore, further research is needed to provide more data and ultimately apply it to guide clinical practice.
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Affiliation(s)
- Mi Yang
- The Comprehensive Cancer Center of Drum Tower Hospital, Medical School of Nanjing University, Nanjing 210008, People's Republic of China.,Cancer Center of Nanjing Gaochun People's Hospital, Nanjing 211300, People's Republic of China
| | - Xiufeng Liu
- Department of Medical Oncology of PLA Cancer Center, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, People's Republic of China
| | - Cheng Zhang
- Department of Gynecology, Jiangsu Province Hospital of Chinese Medicine, Nanjing 210029, People's Republic of China
| | - Feng Liao
- Department of Medical Oncology of PLA Cancer Center, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, People's Republic of China
| | - Zixiong Li
- Department of Medical Oncology of PLA Cancer Center, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, People's Republic of China
| | - Xianwen Luo
- Department of Medical Oncology of PLA Cancer Center, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, People's Republic of China
| | - Yiran Sun
- Department of Clinical Medicine, Xuzhou Medicine University, Xuzhou 221004, People's Republic of China
| | - Chao Chen
- Department of Medical Oncology of PLA Cancer Center, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, People's Republic of China
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Embleton-Thirsk A, Deane E, Townsend S, Farrelly L, Popoola B, Parker J, Rustin G, Sydes M, Parmar M, Ledermann J, Kaplan R. Impact of retrospective data verification to prepare the ICON6 trial for use in a marketing authorization application. Clin Trials 2019; 16:502-511. [PMID: 31347385 PMCID: PMC6801797 DOI: 10.1177/1740774519862528] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background: The ICON6 trial (ISRCTN68510403) is a phase III academic-led, international,
randomized, three-arm, double-blind, placebo-controlled trial of the
addition of cediranib to chemotherapy in recurrent ovarian cancer. It
investigated the use of placebo during chemotherapy and maintenance (arm A),
cediranib alongside chemotherapy followed by placebo maintenance (arm B) and
cediranib throughout both periods (arm C). Results of the primary comparison
showed a meaningful gain in progression-free survival (time to progression
or death from any cause) when comparing arm A (placebo) with arm C
(cediranib). As a consequence of the positive results, AstraZeneca was
engaged with the Medical Research Council trials unit to discuss regulatory
submission using ICON6 as the single pivotal trial. Methods: A relatively limited level of on-site monitoring, single data entry and
investigator’s local evaluation of progression were used on trial. In order
to submit a license application, it was decided that (a) extensive
retrospective source data verification of medical records against case
report forms should be performed, (b) further quality control checks for
accuracy of data entry should be performed and (c) blinded independent
central review of images used to define progression should be undertaken. To
assess the value of these extra activities, we summarize the impact on both
efficacy and safety outcomes. Results: Data point changes were minimal; those key to the primary results had a 0.47%
error rate (36/7686), and supporting data points had a 0.18% error rate
(109/59,261). The impact of the source data verification and quality control
processes were analyzed jointly. The conclusion drawn for the primary
outcome measure of progression-free survival between arm A and arm C was
unchanged. The log-rank test p-value changed only at the sixth decimal
place, the hazard ratio does not change from 0.57 with the exception of a
marginal change in its upper bound (0.74–0.73) and the median
progression-free survival benefit from arm C remained at 2.4 months.
Separately, the blinded independent central review of progression scans was
performed as a sensitivity analysis. Estimates and p values varied slightly
but overall demonstrated a difference in arms, which is consistent with the
initial result. Some increases in toxicity were observed, though these were
generally minor, with the exception of hypertension. However, none of these
increases were systematically biased toward one arm. Conclusion: The conduct of this pragmatic, academic-sponsored trial was sufficient given
the robustness of the results, shown by the results remaining largely
unchanged following retrospective verification despite not being designed
for use in a marketing authorization. The burden of such comprehensive
retrospective effort required to ensure the results of ICON6 were acceptable
to regulators is difficult to justify.
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Affiliation(s)
| | - Elizabeth Deane
- Comprehensive Clinical Trials Unit, University College London, London, UK
| | | | | | | | - Judith Parker
- Edinburgh Clinical Trials Unit, The University of Edinburgh, Edinburgh, UK
| | | | - Matthew Sydes
- MRC Clinical Trials Unit, University College London, London, UK
| | - Mahesh Parmar
- MRC Clinical Trials Unit, University College London, London, UK
| | | | - Richard Kaplan
- MRC Clinical Trials Unit, University College London, London, UK
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Zhang D, Huang J, Sun Y, Guo Q. Long-term progression-free survival of apatinib monotherapy for relapsed ovarian cancer: a case report and literature review. Onco Targets Ther 2019; 12:3635-3644. [PMID: 31190866 PMCID: PMC6529614 DOI: 10.2147/ott.s198946] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 03/27/2019] [Indexed: 12/30/2022] Open
Abstract
Ovarian cancer is the deadliest gynecologic malignancy, which poses a great threat to female health. Anti-angiogenic therapy could bring clinical benefit for patients with ovarian cancer. Apatinib, an oral small-molecule vascular endothelial growth factor receptor-2 inhibitor, has shown notable therapeutic effect in a wide variety of tumors. We report a woman with advanced ovarian cancer who received apatinib at 250 mg/day after failure of multiple-line treatment regimens, followed by discussion through review of literature. The patient has quite a long progression-free survival time of 24 months, with a satisfactory quality of life. Apatinib monotherapy may provide an additional option for advanced ovarian cancer,but it still needs further observation and exploration.
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Affiliation(s)
- Di Zhang
- Shandong Cancer Hospital Affiliated to Shandong University, Shandong University, Jinan 250117, People's Republic of China.,Shandong Academy of Medical Sciences, Shandong Cancer Hospital and Institute, Shandong Cancer Hospital affiliated to Shandong University, Jinan 250117, People's Republic of China
| | - Jiaqi Huang
- Shandong Cancer Hospital Affiliated to Shandong University, Shandong University, Jinan 250117, People's Republic of China.,Shandong Academy of Medical Sciences, Shandong Cancer Hospital and Institute, Shandong Cancer Hospital affiliated to Shandong University, Jinan 250117, People's Republic of China
| | - Yulan Sun
- Shandong Academy of Medical Sciences, Shandong Cancer Hospital and Institute, Shandong Cancer Hospital affiliated to Shandong University, Jinan 250117, People's Republic of China
| | - Qisen Guo
- Shandong Cancer Hospital Affiliated to Shandong University, Shandong University, Jinan 250117, People's Republic of China
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Bevacizumab improves overall survival in platinum refractory ovarian cancer patients: A retrospective study. Taiwan J Obstet Gynecol 2018; 57:819-824. [DOI: 10.1016/j.tjog.2018.10.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2018] [Indexed: 11/19/2022] Open
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Zhang J, Zhang Y, Tang S, Jiang L, He Q, Hamblin LT, He J, Xu Z, Wu J, Chen Y, Liang H, Chen D, Huang Y, Wang X, Deng K, Jiang S, Zhou J, Xu J, Chen X, Liang W, He J. Systematic bias between blinded independent central review and local assessment: literature review and analyses of 76 phase III randomised controlled trials in 45 688 patients with advanced solid tumour. BMJ Open 2018; 8:e017240. [PMID: 30206071 PMCID: PMC6144327 DOI: 10.1136/bmjopen-2017-017240] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 04/11/2018] [Accepted: 07/24/2018] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE Unbiased assessment of tumour response is crucial in randomised controlled trials (RCTs). Blinded independent central review is usually used as a supplemental or monitor to local assessment but is costly. The aim of this study is to investigate whether systematic bias existed in RCTs by comparing the treatment effects of efficacy endpoints between central and local assessments. DESIGN Literature review, pooling analysis and correlation analysis. DATA SOURCES PubMed, from 1 January 2010 to 30 June 2017. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Eligible articles are phase III RCTs comparing anticancer agents for advanced solid tumours. Additionally, the articles should report objective response rate (ORR), disease control rate (DCR), progression-free survival (PFS) or time to progression (TTP); the treatment effect of these endpoints, OR or HR, should be based on central and local assessments. RESULTS Of 76 included trials involving 45 688 patients, 17 (22%) trials reported their endpoints with statistically inconsistent inferences (p value lower/higher than the probability of type I error) between central and local assessments; among them, 9 (53%) trials had statistically significant inference based on central assessment. Pooling analysis presented no systematic bias when comparing treatment effects of both assessments (ORR: OR=1.02 (95% CI 0.97 to 1.07), p=0.42, I2=0%; DCR: OR=0.97 (95% CI 0.92 to 1.03), p=0.32, I2=0%); PFS: HR=1.01 (95% CI 0.99 to 1.02), p=0.32, I2=0%; TTP: HR=1.04 (95% CI 0.95 to 1.14), p=0.37, I2=0%), regardless of funding source, mask, region, tumour type, study design, number of enrolled patients, response assessment criteria, primary endpoint and trials with statistically consistent/inconsistent inferences. Correlation analysis also presented no sign of systematic bias between central and local assessments (ORR, DCR, PFS: r>0.90, p<0.01; TTP: r=0.90, p=0.29). CONCLUSIONS No systematic bias could be found between local and central assessments in phase III RCTs on solid tumours. However, statistically inconsistent inferences could be made in many trials between both assessments.
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Affiliation(s)
- Jianrong Zhang
- Department of Thoracic Surgery and Oncology, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease, Guangzhou, China
- National Clinical Research Centre of Respiratory Disease, Guangzhou, China
- George Warren Brown School, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Yiyin Zhang
- Nanshan School, Guangzhou Medical University, Guangzhou, China
- Department of Pancreatic Surgery/Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Pancreatic Cancer Institute, Fudan University, Shanghai, China
| | - Shiyan Tang
- Nanshan School, Guangzhou Medical University, Guangzhou, China
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Long Jiang
- Department of Thoracic Surgery and Oncology, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease, Guangzhou, China
- National Clinical Research Centre of Respiratory Disease, Guangzhou, China
| | - Qihua He
- Department of Thoracic Surgery and Oncology, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease, Guangzhou, China
- National Clinical Research Centre of Respiratory Disease, Guangzhou, China
| | - Lindsey Tristine Hamblin
- Department of Thoracic Surgery and Oncology, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Institute of International Education, Guangdong University of Foreign Studies, Guangzhou, China
| | - Jiaxi He
- Department of Thoracic Surgery and Oncology, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease, Guangzhou, China
- National Clinical Research Centre of Respiratory Disease, Guangzhou, China
| | - Zhiheng Xu
- Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease, Guangzhou, China
- National Clinical Research Centre of Respiratory Disease, Guangzhou, China
| | - Jieyu Wu
- Department of Pathology, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | - Yaoqi Chen
- Department of Thoracic Surgery and Oncology, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease, Guangzhou, China
- National Clinical Research Centre of Respiratory Disease, Guangzhou, China
| | - Hengrui Liang
- Nanshan School, Guangzhou Medical University, Guangzhou, China
| | - Difei Chen
- Nanshan School, Guangzhou Medical University, Guangzhou, China
| | - Yu Huang
- Nanshan School, Guangzhou Medical University, Guangzhou, China
| | - Xinyu Wang
- Nanshan School, Guangzhou Medical University, Guangzhou, China
| | - Kexin Deng
- Nanshan School, Guangzhou Medical University, Guangzhou, China
| | - Shuhan Jiang
- Nanshan School, Guangzhou Medical University, Guangzhou, China
| | - Jiaqing Zhou
- Nanshan School, Guangzhou Medical University, Guangzhou, China
| | - Jiaxuan Xu
- Nanshan School, Guangzhou Medical University, Guangzhou, China
| | - Xuanzuo Chen
- Nanshan School, Guangzhou Medical University, Guangzhou, China
| | - Wenhua Liang
- Department of Thoracic Surgery and Oncology, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease, Guangzhou, China
- National Clinical Research Centre of Respiratory Disease, Guangzhou, China
| | - Jianxing He
- Department of Thoracic Surgery and Oncology, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease, Guangzhou, China
- National Clinical Research Centre of Respiratory Disease, Guangzhou, China
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Cheng Y, Zhang J, Geng H, Qin S, Hua H. Multiline treatment combining apatinib with toptecan for platinum-resistant recurrent ovarian cancer patients: a report of three cases. Onco Targets Ther 2018; 11:1989-1995. [PMID: 29670374 PMCID: PMC5898585 DOI: 10.2147/ott.s158141] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The aim of this study was to observe the efficacy and safety of apatinib combined with toptecan therapy in the multiline treatment of platinum-resistant recurrent ovarian cancer patients. The clinical records of three patients with platinum-resistant recurrent ovarian cancer treated with apatinib combined with toptecan therapy were analyzed and followed up for 3 months, and the related literatures were reviewed. The three patients achieved partial response and the tumor marker CA125 levels decreased significantly as an outcome of the treatment. Major adverse reactions were hypertension, hand–foot skin reaction, and anemia, which were manageable with medication. Apatinib combined with toptecan multiline therapy in the treatment of platinum-resistant recurrent ovarian cancer patients is effective, and the adverse effects are tolerated. Large-scale studies should be conducted to further determine the efficacy and safety of this treatment protocol.
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Affiliation(s)
- Yuan Cheng
- Department of Medical Oncology, People's Liberation Army Cancer Center, Bayi Hospital Affiliated Nanjing University of Chinese Medicine, Nanjing, China
| | - Juan Zhang
- Department of Medical Oncology, People's Liberation Army Cancer Center, Bayi Hospital Affiliated Nanjing University of Chinese Medicine, Nanjing, China
| | - Haiyun Geng
- Department of Medical Oncology, People's Liberation Army Cancer Center, Bayi Hospital Affiliated Nanjing University of Chinese Medicine, Nanjing, China
| | - Shukui Qin
- Department of Medical Oncology, People's Liberation Army Cancer Center, Bayi Hospital Affiliated Nanjing University of Chinese Medicine, Nanjing, China
| | - Haiqing Hua
- Department of Medical Oncology, People's Liberation Army Cancer Center, Bayi Hospital Affiliated Nanjing University of Chinese Medicine, Nanjing, China
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Correlation between Surgeon's assessment and radiographic evaluation of residual disease in women with advanced stage ovarian cancer reported to have undergone optimal surgical cytoreduction: An NRG Oncology/Gynecologic Oncology Group study. Gynecol Oncol 2018; 149:525-530. [PMID: 29550184 DOI: 10.1016/j.ygyno.2018.03.043] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 03/07/2018] [Accepted: 03/09/2018] [Indexed: 11/23/2022]
Abstract
PURPOSE We sought to determine the level of concordance among surgeons' assessment of residual disease (RD) and pre-treatment computed tomography (CT) findings among women who underwent optimal surgical cytoreduction for advanced stage ovarian cancer. METHODS This is a post-trial ad hoc analysis of a phase 3 randomized clinical trial evaluating the impact of bevacizumab in primary and maintenance therapy for patients with advanced stage ovarian cancer following surgical cytoreduction. All subjects underwent imaging of the chest/abdomen/pelvis to establish a post-surgical baseline prior to the initiation of chemotherapy. Information collected on trial was utilized to compare surgeon's operative assessment of RD, to pre-treatment imaging. RESULTS Of 1873 enrolled patients, surgical outcome was described as optimal (RD≤1cm) in 639 subjects. Twelve patients were excluded as they did not have a baseline, pretreatment imaging, leaving 627 participants for analysis. The average interval from surgery to baseline scan was 26days (range: 1-109). In 251 cases (40%), the post-operative scan was discordant with surgeon assessment, demonstrating RD>1cm in size. RD>1cm was most commonly identified in the right upper quadrant (28.4%), retroperitoneal para-aortic lymph nodes (RD>1.5cm; 28.2%) and the left upper quadrant (10.7%). Patients with RD>1cm on pre-treatment CT (discordant) exhibited a significantly greater risk of disease progression (HR 1.30; 95% CI 1.08-1.56; p=0.0059). CONCLUSIONS Among patients reported to have undergone optimal cytoreduction, 40% were found to have lesions >1cm on postoperative, pretreatment imaging. Although inflammatory changes and/or rapid tumor regrowth could account for the discordance, the impact on PFS and distribution of RD may suggest underestimation by the operating surgeon.
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Rojas V, Hirshfield KM, Ganesan S, Rodriguez-Rodriguez L. Molecular Characterization of Epithelial Ovarian Cancer: Implications for Diagnosis and Treatment. Int J Mol Sci 2016; 17:ijms17122113. [PMID: 27983698 PMCID: PMC5187913 DOI: 10.3390/ijms17122113] [Citation(s) in RCA: 134] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 11/30/2016] [Accepted: 12/06/2016] [Indexed: 12/27/2022] Open
Abstract
Epithelial ovarian cancer is a highly heterogeneous disease characterized by multiple histological subtypes. Molecular diversity has been shown to occur within specific histological subtypes of epithelial ovarian cancer, between different tumors of an individual patient, as well as within individual tumors. Recent advances in the molecular characterization of epithelial ovarian cancer tumors have provided the basis for a simplified classification scheme in which these cancers are classified as either type I or type II tumors, and these two categories have implications regarding disease pathogenesis and prognosis. Molecular analyses, primarily based on next-generation sequencing, otherwise known as high-throughput sequencing, are allowing for further refinement of ovarian cancer classification, facilitating the elucidation of the site(s) of precursor lesions of high-grade serous ovarian cancer, and providing insight into the processes of clonal selection and evolution that may be associated with development of chemoresistance. Potential therapeutic targets have been identified from recent molecular profiling studies of these tumors, and the effectiveness and safety of a number of specific targeted therapies have been evaluated or are currently being studied for the treatment of women with this disease.
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Affiliation(s)
- Veronica Rojas
- Department Obstetrics/Gynecology and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, 125 Paterson Street, New Brunswick, NJ 08901, USA.
| | - Kim M Hirshfield
- Department of Medicine, Division of Medical Oncology, Rutgers Robert Wood Johnson Medical School, Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, New Brunswick, NJ 08903, USA.
- Precision Medicine Oncology, Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, New Brunswick, NJ 08903, USA.
| | - Shridar Ganesan
- Department of Medicine, Division of Medical Oncology, Rutgers Robert Wood Johnson Medical School, Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, New Brunswick, NJ 08903, USA.
- Precision Medicine Oncology, Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, New Brunswick, NJ 08903, USA.
| | - Lorna Rodriguez-Rodriguez
- Precision Medicine Oncology, Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, New Brunswick, NJ 08903, USA.
- Department Obstetrics/Gynecology and Reproductive Sciences, Division of Gynecologic Oncology, Rutgers Robert Wood Johnson Medical School, Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, New Brunswick, NJ 08903, USA.
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Evans J, Laking G, Strother M, Wang T, Metcalfe S, Blick G, Pauls R, Crausaz S. Mind the gap: An analysis of foregone health gains from unfunded cancer medicines in New Zealand. Semin Oncol 2016; 43:625-637. [DOI: 10.1053/j.seminoncol.2016.10.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 10/22/2016] [Indexed: 11/11/2022]
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Wang Y, Qiu Y, Thai T, Moore K, Liu H, Zheng B. Applying a computer-aided scheme to detect a new radiographic image marker for prediction of chemotherapy outcome. BMC Med Imaging 2016; 16:52. [PMID: 27581075 PMCID: PMC5006425 DOI: 10.1186/s12880-016-0157-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 08/17/2016] [Indexed: 01/03/2023] Open
Abstract
Background To investigate the feasibility of automated segmentation of visceral and subcutaneous fat areas from computed tomography (CT) images of ovarian cancer patients and applying the computed adiposity-related image features to predict chemotherapy outcome. Methods A computerized image processing scheme was developed to segment visceral and subcutaneous fat areas, and compute adiposity-related image features. Then, logistic regression models were applied to analyze association between the scheme-generated assessment scores and progression-free survival (PFS) of patients using a leave-one-case-out cross-validation method and a dataset involving 32 patients. Results The correlation coefficients between automated and radiologist’s manual segmentation of visceral and subcutaneous fat areas were 0.76 and 0.89, respectively. The scheme-generated prediction scores using adiposity-related radiographic image features significantly associated with patients’ PFS (p < 0.01). Conclusion Using a computerized scheme enables to more efficiently and robustly segment visceral and subcutaneous fat areas. The computed adiposity-related image features also have potential to improve accuracy in predicting chemotherapy outcome.
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Affiliation(s)
- Yunzhi Wang
- School of Electrical and Computer Engineering, University of Oklahoma, Norman, OK, 73019, USA.
| | - Yuchen Qiu
- School of Electrical and Computer Engineering, University of Oklahoma, Norman, OK, 73019, USA
| | - Theresa Thai
- Health Science Center of University of Oklahoma, Oklahoma City, OK, 73104, USA
| | - Kathleen Moore
- Health Science Center of University of Oklahoma, Oklahoma City, OK, 73104, USA
| | - Hong Liu
- School of Electrical and Computer Engineering, University of Oklahoma, Norman, OK, 73019, USA
| | - Bin Zheng
- School of Electrical and Computer Engineering, University of Oklahoma, Norman, OK, 73019, USA
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Ai B, Bie Z, Zhang S, Li A. Paclitaxel targets VEGF-mediated angiogenesis in ovarian cancer treatment. Am J Cancer Res 2016; 6:1624-1635. [PMID: 27648354 PMCID: PMC5004068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 07/25/2016] [Indexed: 06/06/2023] Open
Abstract
Ovarian cancer is one of the gynecologic cancers with the highest mortality, wherein vascular endothelial growth factor (VEGF) is involved in regulating tumor vascularization, growth, migration, and invasion. VEGF-mediated angiogenesis in tumors has been targeted in various cancer treatments, and anti-VEGF therapy has been used clinically for treatment of several types of cancer. Paclitaxel is a natural antitumor agent in the standard front-line treatment that has significant efficiency to treat advanced cancers, including ovarian cancer. Although platinum/paclitaxel-based chemotherapy has good response rates, most patients eventually relapse because the disease develops drug resistance. We aim to review the recent advances in paclitaxel treatment of ovarian cancer via antiangiogenesis. Single-agent therapy may be used in selected cases of ovarian cancer. However, to prevent drug resistance, drug combinations should be identified for optimal effectiveness and existing therapies should be improved.
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Affiliation(s)
- Bin Ai
- Department of Medical Oncology, Beijing Hospital, National Center of GerontologyBeijing 100730, China
| | - Zhixin Bie
- Department of Medical Oncology, Beijing Hospital, National Center of GerontologyBeijing 100730, China
| | - Shuai Zhang
- Department of Medical Oncology, Beijing Hospital, National Center of GerontologyBeijing 100730, China
| | - Ailing Li
- Institute of Microcirculation, PUMC&CAMSBeijing 100005, China
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24
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Kurzeder C, Bover I, Marmé F, Rau J, Pautier P, Colombo N, Lorusso D, Ottevanger P, Bjurberg M, Marth C, Barretina-Ginesta P, Vergote I, Floquet A, del Campo JM, Mahner S, Bastière-Truchot L, Martin N, Oestergaard MZ, Kiermaier A, Schade-Brittinger C, Polleis S, du Bois A, Gonzalez-Martin A. Double-Blind, Placebo-Controlled, Randomized Phase III Trial Evaluating Pertuzumab Combined With Chemotherapy for Low Tumor Human Epidermal Growth Factor Receptor 3 mRNA–Expressing Platinum-Resistant Ovarian Cancer (PENELOPE). J Clin Oncol 2016; 34:2516-25. [DOI: 10.1200/jco.2015.66.0787] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose The AGO-OVAR 2.29/ENGOT-ov14/PENELOPE prospectively randomized phase III trial evaluated the addition of pertuzumab to chemotherapy in patients with platinum-resistant ovarian carcinoma with low tumor human epidermal growth factor receptor 3 (HER3) mRNA expression. We report the results of the primary efficacy analysis. Patients and Methods Eligible patients had ovarian carcinoma that progressed during or within 6 months of completing four or more platinum cycles, centrally tested low tumor HER3 mRNA expression (concentration ratio ≤ 2.81 by quantitative reverse transcriptase polymerase chain reaction on cobas z480 [Roche Molecular Diagnostics, Pleasanton, CA]), and no more than two prior lines of chemotherapy. After investigators’ selection of the chemotherapy backbone (single-agent topotecan, weekly paclitaxel, or gemcitabine), patients were randomly assigned to also receive either placebo or pertuzumab (840-mg loading dose followed by 420 mg every 3 weeks). Stratification factors were selected chemotherapy, prior antiangiogenic therapy, and platinum-free interval. The primary end point was independent review committee–assessed progression-free survival (PFS). Additional end points included overall survival, investigator-assessed PFS, objective response rate, safety, patient-reported outcomes, and translational research. Results Overall, 156 patients were randomly assigned. Adding pertuzumab to chemotherapy did not significantly improve independent review committee–assessed PFS for the primary analysis (stratified hazard ratio, 0.74; 95% CI, 0.50 to 1.11; P = .14; median PFS, 4.3 months for pertuzumab plus chemotherapy v 2.6 months for placebo plus chemotherapy). Sensitivity analyses and secondary efficacy end point results were consistent with the primary analysis. The effect on PFS favoring pertuzumab was more pronounced in the gemcitabine and paclitaxel cohorts. No new safety signals were seen. Conclusion Although the primary objective was not met, subgroup analyses showed trends in PFS favoring pertuzumab in the gemcitabine and paclitaxel cohorts, meriting further exploration of pertuzumab in ovarian cancer.
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Affiliation(s)
- Christian Kurzeder
- Christian Kurzeder and Andreas du Bois, Arbeitsgemeinschaft Gynäkologische Onkologie (AGO) and Kliniken Essen Mitte, Essen; Frederik Marmé, AGO and University Hospital Heidelberg, Heidelberg; Joern Rau and Carmen Schade-Brittinger, Coordinating Center for Clinical Trials, Philipps-University of Marburg, Marburg; Sven Mahner, AGO and University Medical Center Hamburg-Eppendorf, Hamburg; Sandra Polleis, AGO Study Group, Wiesbaden, Germany; Isabel Bover, Grupo Español de Investigación en Cáncer de Ovario
| | - Isabel Bover
- Christian Kurzeder and Andreas du Bois, Arbeitsgemeinschaft Gynäkologische Onkologie (AGO) and Kliniken Essen Mitte, Essen; Frederik Marmé, AGO and University Hospital Heidelberg, Heidelberg; Joern Rau and Carmen Schade-Brittinger, Coordinating Center for Clinical Trials, Philipps-University of Marburg, Marburg; Sven Mahner, AGO and University Medical Center Hamburg-Eppendorf, Hamburg; Sandra Polleis, AGO Study Group, Wiesbaden, Germany; Isabel Bover, Grupo Español de Investigación en Cáncer de Ovario
| | - Frederik Marmé
- Christian Kurzeder and Andreas du Bois, Arbeitsgemeinschaft Gynäkologische Onkologie (AGO) and Kliniken Essen Mitte, Essen; Frederik Marmé, AGO and University Hospital Heidelberg, Heidelberg; Joern Rau and Carmen Schade-Brittinger, Coordinating Center for Clinical Trials, Philipps-University of Marburg, Marburg; Sven Mahner, AGO and University Medical Center Hamburg-Eppendorf, Hamburg; Sandra Polleis, AGO Study Group, Wiesbaden, Germany; Isabel Bover, Grupo Español de Investigación en Cáncer de Ovario
| | - Joern Rau
- Christian Kurzeder and Andreas du Bois, Arbeitsgemeinschaft Gynäkologische Onkologie (AGO) and Kliniken Essen Mitte, Essen; Frederik Marmé, AGO and University Hospital Heidelberg, Heidelberg; Joern Rau and Carmen Schade-Brittinger, Coordinating Center for Clinical Trials, Philipps-University of Marburg, Marburg; Sven Mahner, AGO and University Medical Center Hamburg-Eppendorf, Hamburg; Sandra Polleis, AGO Study Group, Wiesbaden, Germany; Isabel Bover, Grupo Español de Investigación en Cáncer de Ovario
| | - Patricia Pautier
- Christian Kurzeder and Andreas du Bois, Arbeitsgemeinschaft Gynäkologische Onkologie (AGO) and Kliniken Essen Mitte, Essen; Frederik Marmé, AGO and University Hospital Heidelberg, Heidelberg; Joern Rau and Carmen Schade-Brittinger, Coordinating Center for Clinical Trials, Philipps-University of Marburg, Marburg; Sven Mahner, AGO and University Medical Center Hamburg-Eppendorf, Hamburg; Sandra Polleis, AGO Study Group, Wiesbaden, Germany; Isabel Bover, Grupo Español de Investigación en Cáncer de Ovario
| | - Nicoletta Colombo
- Christian Kurzeder and Andreas du Bois, Arbeitsgemeinschaft Gynäkologische Onkologie (AGO) and Kliniken Essen Mitte, Essen; Frederik Marmé, AGO and University Hospital Heidelberg, Heidelberg; Joern Rau and Carmen Schade-Brittinger, Coordinating Center for Clinical Trials, Philipps-University of Marburg, Marburg; Sven Mahner, AGO and University Medical Center Hamburg-Eppendorf, Hamburg; Sandra Polleis, AGO Study Group, Wiesbaden, Germany; Isabel Bover, Grupo Español de Investigación en Cáncer de Ovario
| | - Domenica Lorusso
- Christian Kurzeder and Andreas du Bois, Arbeitsgemeinschaft Gynäkologische Onkologie (AGO) and Kliniken Essen Mitte, Essen; Frederik Marmé, AGO and University Hospital Heidelberg, Heidelberg; Joern Rau and Carmen Schade-Brittinger, Coordinating Center for Clinical Trials, Philipps-University of Marburg, Marburg; Sven Mahner, AGO and University Medical Center Hamburg-Eppendorf, Hamburg; Sandra Polleis, AGO Study Group, Wiesbaden, Germany; Isabel Bover, Grupo Español de Investigación en Cáncer de Ovario
| | - Petronella Ottevanger
- Christian Kurzeder and Andreas du Bois, Arbeitsgemeinschaft Gynäkologische Onkologie (AGO) and Kliniken Essen Mitte, Essen; Frederik Marmé, AGO and University Hospital Heidelberg, Heidelberg; Joern Rau and Carmen Schade-Brittinger, Coordinating Center for Clinical Trials, Philipps-University of Marburg, Marburg; Sven Mahner, AGO and University Medical Center Hamburg-Eppendorf, Hamburg; Sandra Polleis, AGO Study Group, Wiesbaden, Germany; Isabel Bover, Grupo Español de Investigación en Cáncer de Ovario
| | - Maria Bjurberg
- Christian Kurzeder and Andreas du Bois, Arbeitsgemeinschaft Gynäkologische Onkologie (AGO) and Kliniken Essen Mitte, Essen; Frederik Marmé, AGO and University Hospital Heidelberg, Heidelberg; Joern Rau and Carmen Schade-Brittinger, Coordinating Center for Clinical Trials, Philipps-University of Marburg, Marburg; Sven Mahner, AGO and University Medical Center Hamburg-Eppendorf, Hamburg; Sandra Polleis, AGO Study Group, Wiesbaden, Germany; Isabel Bover, Grupo Español de Investigación en Cáncer de Ovario
| | - Christian Marth
- Christian Kurzeder and Andreas du Bois, Arbeitsgemeinschaft Gynäkologische Onkologie (AGO) and Kliniken Essen Mitte, Essen; Frederik Marmé, AGO and University Hospital Heidelberg, Heidelberg; Joern Rau and Carmen Schade-Brittinger, Coordinating Center for Clinical Trials, Philipps-University of Marburg, Marburg; Sven Mahner, AGO and University Medical Center Hamburg-Eppendorf, Hamburg; Sandra Polleis, AGO Study Group, Wiesbaden, Germany; Isabel Bover, Grupo Español de Investigación en Cáncer de Ovario
| | - Pilar Barretina-Ginesta
- Christian Kurzeder and Andreas du Bois, Arbeitsgemeinschaft Gynäkologische Onkologie (AGO) and Kliniken Essen Mitte, Essen; Frederik Marmé, AGO and University Hospital Heidelberg, Heidelberg; Joern Rau and Carmen Schade-Brittinger, Coordinating Center for Clinical Trials, Philipps-University of Marburg, Marburg; Sven Mahner, AGO and University Medical Center Hamburg-Eppendorf, Hamburg; Sandra Polleis, AGO Study Group, Wiesbaden, Germany; Isabel Bover, Grupo Español de Investigación en Cáncer de Ovario
| | - Ignace Vergote
- Christian Kurzeder and Andreas du Bois, Arbeitsgemeinschaft Gynäkologische Onkologie (AGO) and Kliniken Essen Mitte, Essen; Frederik Marmé, AGO and University Hospital Heidelberg, Heidelberg; Joern Rau and Carmen Schade-Brittinger, Coordinating Center for Clinical Trials, Philipps-University of Marburg, Marburg; Sven Mahner, AGO and University Medical Center Hamburg-Eppendorf, Hamburg; Sandra Polleis, AGO Study Group, Wiesbaden, Germany; Isabel Bover, Grupo Español de Investigación en Cáncer de Ovario
| | - Anne Floquet
- Christian Kurzeder and Andreas du Bois, Arbeitsgemeinschaft Gynäkologische Onkologie (AGO) and Kliniken Essen Mitte, Essen; Frederik Marmé, AGO and University Hospital Heidelberg, Heidelberg; Joern Rau and Carmen Schade-Brittinger, Coordinating Center for Clinical Trials, Philipps-University of Marburg, Marburg; Sven Mahner, AGO and University Medical Center Hamburg-Eppendorf, Hamburg; Sandra Polleis, AGO Study Group, Wiesbaden, Germany; Isabel Bover, Grupo Español de Investigación en Cáncer de Ovario
| | - Josep M. del Campo
- Christian Kurzeder and Andreas du Bois, Arbeitsgemeinschaft Gynäkologische Onkologie (AGO) and Kliniken Essen Mitte, Essen; Frederik Marmé, AGO and University Hospital Heidelberg, Heidelberg; Joern Rau and Carmen Schade-Brittinger, Coordinating Center for Clinical Trials, Philipps-University of Marburg, Marburg; Sven Mahner, AGO and University Medical Center Hamburg-Eppendorf, Hamburg; Sandra Polleis, AGO Study Group, Wiesbaden, Germany; Isabel Bover, Grupo Español de Investigación en Cáncer de Ovario
| | - Sven Mahner
- Christian Kurzeder and Andreas du Bois, Arbeitsgemeinschaft Gynäkologische Onkologie (AGO) and Kliniken Essen Mitte, Essen; Frederik Marmé, AGO and University Hospital Heidelberg, Heidelberg; Joern Rau and Carmen Schade-Brittinger, Coordinating Center for Clinical Trials, Philipps-University of Marburg, Marburg; Sven Mahner, AGO and University Medical Center Hamburg-Eppendorf, Hamburg; Sandra Polleis, AGO Study Group, Wiesbaden, Germany; Isabel Bover, Grupo Español de Investigación en Cáncer de Ovario
| | - Lydie Bastière-Truchot
- Christian Kurzeder and Andreas du Bois, Arbeitsgemeinschaft Gynäkologische Onkologie (AGO) and Kliniken Essen Mitte, Essen; Frederik Marmé, AGO and University Hospital Heidelberg, Heidelberg; Joern Rau and Carmen Schade-Brittinger, Coordinating Center for Clinical Trials, Philipps-University of Marburg, Marburg; Sven Mahner, AGO and University Medical Center Hamburg-Eppendorf, Hamburg; Sandra Polleis, AGO Study Group, Wiesbaden, Germany; Isabel Bover, Grupo Español de Investigación en Cáncer de Ovario
| | - Nicolas Martin
- Christian Kurzeder and Andreas du Bois, Arbeitsgemeinschaft Gynäkologische Onkologie (AGO) and Kliniken Essen Mitte, Essen; Frederik Marmé, AGO and University Hospital Heidelberg, Heidelberg; Joern Rau and Carmen Schade-Brittinger, Coordinating Center for Clinical Trials, Philipps-University of Marburg, Marburg; Sven Mahner, AGO and University Medical Center Hamburg-Eppendorf, Hamburg; Sandra Polleis, AGO Study Group, Wiesbaden, Germany; Isabel Bover, Grupo Español de Investigación en Cáncer de Ovario
| | - Mikkel Z. Oestergaard
- Christian Kurzeder and Andreas du Bois, Arbeitsgemeinschaft Gynäkologische Onkologie (AGO) and Kliniken Essen Mitte, Essen; Frederik Marmé, AGO and University Hospital Heidelberg, Heidelberg; Joern Rau and Carmen Schade-Brittinger, Coordinating Center for Clinical Trials, Philipps-University of Marburg, Marburg; Sven Mahner, AGO and University Medical Center Hamburg-Eppendorf, Hamburg; Sandra Polleis, AGO Study Group, Wiesbaden, Germany; Isabel Bover, Grupo Español de Investigación en Cáncer de Ovario
| | - Astrid Kiermaier
- Christian Kurzeder and Andreas du Bois, Arbeitsgemeinschaft Gynäkologische Onkologie (AGO) and Kliniken Essen Mitte, Essen; Frederik Marmé, AGO and University Hospital Heidelberg, Heidelberg; Joern Rau and Carmen Schade-Brittinger, Coordinating Center for Clinical Trials, Philipps-University of Marburg, Marburg; Sven Mahner, AGO and University Medical Center Hamburg-Eppendorf, Hamburg; Sandra Polleis, AGO Study Group, Wiesbaden, Germany; Isabel Bover, Grupo Español de Investigación en Cáncer de Ovario
| | - Carmen Schade-Brittinger
- Christian Kurzeder and Andreas du Bois, Arbeitsgemeinschaft Gynäkologische Onkologie (AGO) and Kliniken Essen Mitte, Essen; Frederik Marmé, AGO and University Hospital Heidelberg, Heidelberg; Joern Rau and Carmen Schade-Brittinger, Coordinating Center for Clinical Trials, Philipps-University of Marburg, Marburg; Sven Mahner, AGO and University Medical Center Hamburg-Eppendorf, Hamburg; Sandra Polleis, AGO Study Group, Wiesbaden, Germany; Isabel Bover, Grupo Español de Investigación en Cáncer de Ovario
| | - Sandra Polleis
- Christian Kurzeder and Andreas du Bois, Arbeitsgemeinschaft Gynäkologische Onkologie (AGO) and Kliniken Essen Mitte, Essen; Frederik Marmé, AGO and University Hospital Heidelberg, Heidelberg; Joern Rau and Carmen Schade-Brittinger, Coordinating Center for Clinical Trials, Philipps-University of Marburg, Marburg; Sven Mahner, AGO and University Medical Center Hamburg-Eppendorf, Hamburg; Sandra Polleis, AGO Study Group, Wiesbaden, Germany; Isabel Bover, Grupo Español de Investigación en Cáncer de Ovario
| | - Andreas du Bois
- Christian Kurzeder and Andreas du Bois, Arbeitsgemeinschaft Gynäkologische Onkologie (AGO) and Kliniken Essen Mitte, Essen; Frederik Marmé, AGO and University Hospital Heidelberg, Heidelberg; Joern Rau and Carmen Schade-Brittinger, Coordinating Center for Clinical Trials, Philipps-University of Marburg, Marburg; Sven Mahner, AGO and University Medical Center Hamburg-Eppendorf, Hamburg; Sandra Polleis, AGO Study Group, Wiesbaden, Germany; Isabel Bover, Grupo Español de Investigación en Cáncer de Ovario
| | - Antonio Gonzalez-Martin
- Christian Kurzeder and Andreas du Bois, Arbeitsgemeinschaft Gynäkologische Onkologie (AGO) and Kliniken Essen Mitte, Essen; Frederik Marmé, AGO and University Hospital Heidelberg, Heidelberg; Joern Rau and Carmen Schade-Brittinger, Coordinating Center for Clinical Trials, Philipps-University of Marburg, Marburg; Sven Mahner, AGO and University Medical Center Hamburg-Eppendorf, Hamburg; Sandra Polleis, AGO Study Group, Wiesbaden, Germany; Isabel Bover, Grupo Español de Investigación en Cáncer de Ovario
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Independent radiologic review of AURELIA, a phase 3 trial of bevacizumab plus chemotherapy for platinum-resistant recurrent ovarian cancer. Gynecol Oncol 2016; 142:465-70. [PMID: 27184721 DOI: 10.1016/j.ygyno.2016.05.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 05/10/2016] [Accepted: 05/11/2016] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The randomized, open-label, phase 3 Avastin® Use in Platinum-Resistant Epithelial Ovarian Cancer (AURELIA) trial achieved its primary efficacy end point of significantly improved progression-free survival (PFS) in patients treated with bevacizumab in combination with chemotherapy (CT) compared with CT alone for platinum-resistant, recurrent ovarian cancer. Primary analyses were conducted via investigator assessment of PFS; to confirm primary results, an independent review committee (IRC) retrospectively assessed radiographic data. METHODS Per an amendment to the original study protocol, the IRC reviewed radiographic data from 298 (82.5%) patients in a blinded manner using the Response Evaluation Criteria in Solid Tumors (modified version 1.0). IRC-assessed PFS and concordance between the two assessments were evaluated. RESULTS IRC assessment demonstrated that PFS was significantly prolonged for patients treated with CT+bevacizumab compared with CT alone (median, 8.1 vs. 3.9months; hazard ratio, 0.484; 95% confidence interval, 0.370-0.632; P<0.0001). Results were similar to the primary PFS analysis from investigator assessment (median, 6.8 vs. 3.4months; hazard ratio, 0.384; 95% confidence interval, 0.300-0.491; P<0.0001). Concordance rates for progressive disease status (CT+bevacizumab, 68.2%; CT, 69.9%) and date (CT+bevacizumab, 67.2%; CT, 69.1%) were similar across treatment arms. Among 161 IRC-evaluable patients declared to have progressive disease by investigator and IRC assessment, 68.3% progressed on the same date as determined by both investigator and IRC. CONCLUSIONS IRC assessment of PFS confirmed the investigator-assessed PFS improvement for patients treated with CT+bevacizumab compared with CT alone in the AURELIA study.
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Wang Y, Thai T, Moore K, Ding K, McMeekin S, Liu H, Zheng B. Quantitative measurement of adiposity using CT images to predict the benefit of bevacizumab-based chemotherapy in epithelial ovarian cancer patients. Oncol Lett 2016; 12:680-686. [PMID: 27347200 DOI: 10.3892/ol.2016.4648] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 05/12/2016] [Indexed: 12/23/2022] Open
Abstract
The present study aims to quantitatively measure adiposity-related image features and to test the feasibility of applying multivariate statistical data analysis-based prediction models to generate a novel clinical marker and predict the benefit of epithelial ovarian cancer (EOC) patients with and without maintenance bevacizumab-based chemotherapy. A dataset involving computed tomography (CT) images acquired from 59 patients diagnosed with advanced EOC was retrospectively collected. Among them, 32 patients received maintenance bevacizumab following primary chemotherapy, while 27 did not. A computer-aided detection scheme was developed to automatically segment visceral and subcutaneous fat areas depicted on CT images of abdominal sections, and 7 adiposity-related image features were computed. Upon combining these features with the measured body mass index, multivariate data analyses were performed using three statistical models (multiple linear, logistic and Cox proportional hazards regressions) to analyze the association between the model-generated prediction results and the treatment outcome, including progression-free survival (PFS) and overall survival (OS) of the patients. The results demonstrated that applying all three prediction models yielded a significant association between the adiposity-related image features and patients' PFS or OS in the group of the patients who received maintenance bevacizumab (P<0.010), while there was no significant difference when these prediction models were applied to predict both PFS and OS in the group of patients that did not receive maintenance bevacizumab. Therefore, the present study demonstrated that the use of a quantitative adiposity-related image feature-based statistical model may generate a novel clinical marker to predict who will benefit among EOC patients receiving maintenance bevacizumab-based chemotherapy.
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Affiliation(s)
- Yunzhi Wang
- School of Electrical and Computer Engineering, University of Oklahoma, Norman, OK 73019, USA
| | - Theresa Thai
- Health Science Center of University of Oklahoma, Oklahoma, OK 73104, USA
| | - Kathleen Moore
- Health Science Center of University of Oklahoma, Oklahoma, OK 73104, USA
| | - Kai Ding
- Health Science Center of University of Oklahoma, Oklahoma, OK 73104, USA
| | - Scott McMeekin
- Health Science Center of University of Oklahoma, Oklahoma, OK 73104, USA
| | - Hong Liu
- School of Electrical and Computer Engineering, University of Oklahoma, Norman, OK 73019, USA
| | - Bin Zheng
- School of Electrical and Computer Engineering, University of Oklahoma, Norman, OK 73019, USA
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Abstract
The humanized monoclonal antibody bevacizumab (Avastin(®)) has been available in the EU since 2005. Results of phase III trials demonstrate that adding intravenous bevacizumab to antineoplastic agents improves progression-free survival and/or overall survival in patients with advanced cancer, including when used as first- or second-line therapy in metastatic colorectal cancer, as first-line therapy in advanced nonsquamous non-small cell lung cancer, as first-line therapy in metastatic renal cell carcinoma, as first-line therapy in metastatic breast cancer, and as first-line therapy in epithelial ovarian, fallopian tube or primary peritoneal cancer or in recurrent, platinum-sensitive or platinum-resistant disease. Results of these studies are supported by the findings of routine oncology practice studies conducted in real-world settings. The tolerability profile of bevacizumab is well defined and adverse events associated with its use (e.g. hypertension, proteinuria, haemorrhage, wound healing complications, arterial thromboembolism, gastrointestinal perforation) are generally manageable. In conclusion, bevacizumab remains an important option for use in patients with advanced cancer.
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Affiliation(s)
- Gillian M Keating
- Springer, Private Bag 65901, Mairangi Bay, 0754, Auckland, New Zealand.
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Colombo N, Conte PF, Pignata S, Raspagliesi F, Scambia G. Bevacizumab in ovarian cancer: Focus on clinical data and future perspectives. Crit Rev Oncol Hematol 2015; 97:335-48. [PMID: 26555461 DOI: 10.1016/j.critrevonc.2015.08.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 07/17/2015] [Accepted: 08/06/2015] [Indexed: 10/23/2022] Open
Abstract
The past five years have yielded substantial developments in the management of advanced ovarian cancer. Initial promise shown by anti-angiogenic agents has translated into positive phase III trials in the front-line and recurrent settings. Nevertheless, several questions remain unanswered, including the most appropriate timing for initiation of anti-angiogenic therapy and patient selection for the various treatment approaches. This review article summarises the key results (including final overall survival data), from five pivotal phase III trials of bevacizumab, highlights emerging data with new maintenance strategies and considers unanswered questions and ongoing research to address uncertainties in treatment duration, re-exposure to bevacizumab in bevacizumab-pretreated patients and the potential integration of anti-angiogenic therapy into neoadjuvant treatment regimens.
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Affiliation(s)
- Nicoletta Colombo
- University of Milan Bicocca and European Institute of Oncology, via Ripamonti 435, Milan, Italy.
| | - Pier Franco Conte
- Department of Surgery, Oncology and Gastroenterology, University of Padova and Division of Medical Oncology 2, Oncology Institute of Veneto, Padova, Italy.
| | - Sandro Pignata
- Department of Urology and Gynecology, Istituto Nazionale Tumori Fondazione G. Pascale - IRCCS, Naples, Italy.
| | - Francesco Raspagliesi
- Surgical Gynecology, Fondazione IRCCS, Istituto Nazionale dei Tumori di Milano, Milan, Italy.
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Floquet A, Vergote I, Colombo N, Fiane B, Monk BJ, Reinthaller A, Calvert P, Herzog TJ, Meier W, Kim JW, del Campo JM, Friedlander M, Pisano C, Isonishi S, Crescenzo RJ, Barrett C, Wang K, Mitrica I, du Bois A. Progression-free survival by local investigator versus independent central review: comparative analysis of the AGO-OVAR16 Trial. Gynecol Oncol 2014; 136:37-42. [PMID: 25434635 DOI: 10.1016/j.ygyno.2014.11.074] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 11/21/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Analysis of progression-free survival (PFS) as the primary endpoint in advanced epithelial ovarian, fallopian tube, and primary peritoneal cancer (AEOC) trials may be confounded by the difficulty of radiologic evaluation of disease progression and the potential for discrepancy between investigator and blinded independent central assessments. PFS as assessed by local investigator (INV) was the primary endpoint of AGO-OVAR16, a randomized, double-blind trial of pazopanib maintenance therapy in AEOC. To confirm the robustness of the primary analysis, PFS was also evaluated by blinded independent central review (BICR). METHODS Patients with histologically confirmed AEOC (N = 940) were randomized 1:1 to receive pazopanib 800 mg/day or placebo for up to 24 months. Tumor response in the intent-to-treat population was evaluated by CT/MRI every 6 months and analyzed per RECIST 1.0. RESULTS Pazopanib prolonged PFS versus placebo by INV (median 17.9 vs 12.3 months; hazard ratio [HR] = 0.766, 95% confidence interval [CI]: 0.643-0.911; P = 0.0021). Results for PFS by BICR were similar (median 15.4 vs 11.8 months; HR = 0.802, 95% CI: 0.678-0.949; P = 0.0084). Progression events were recorded later by INV in 23% of pazopanib-treated patients and 17% of placebo-treated patients. The overall concordance between INV and BICR assessments was 84% and 86% in the pazopanib and placebo arms, respectively. CONCLUSIONS By INV and BICR assessments, maintenance therapy with pazopanib in AEOC provided a significantly longer PFS than placebo. The good overall concordance between INV and BICR assessments, as well as HR and P value consistency, supports the reliability of investigator-assessed PFS as the primary endpoint in AGO-OVAR16.
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Affiliation(s)
| | - Ignace Vergote
- University Hospitals Leuven, Dept. of Gynaecological Oncology, Leuven, Belgium
| | - Nicoletta Colombo
- University of Milan Bicocca and European Institute of Oncology, Gynecologic Oncology, Milan, Italy
| | - Bent Fiane
- Department of Gynecology and Gynecologic Oncology, Stavanger University Hospital, Stavanger, Norway
| | - Bradley J Monk
- Creighton University School of Medicine at St. Joseph's Hospital and Medical Center, Division of Gynecologic Oncology, Phoenix, AZ, USA
| | | | - Paula Calvert
- All-Ireland Co-operative Oncology Group, Dublin, Ireland
| | - Thomas J Herzog
- University of Cincinnati Cancer Institute, Cincinnati, OH, USA
| | - Werner Meier
- Evangelisches Krankenhaus Düsseldorf, Düsseldorf, Germany
| | - Jae-Weon Kim
- Department of Obstetrics and Gynecology, Seoul National University, Seoul, Republic of Korea
| | - Josep M del Campo
- Vall d'Hebron University Hospital, Dept. of Medical Oncology, Barcelona, Spain
| | - Michael Friedlander
- The Prince of Wales Cancer Center, Dept. of Medical Oncology, Randwick, NSW, Australia
| | - Carmela Pisano
- Department of Uro-gynecologic Oncology, Istituto Nazionale Tumori Fondazione G Pascale-IRCCS, Naples, Italy
| | - Seiji Isonishi
- Department of Obstetrics and Gynecology, Jikei University School of Medicine, Daisan Hospital, Tokyo, Japan
| | | | | | | | | | - Andreas du Bois
- Department of Gynecology and Gynecologic Oncology, Kliniken Essen Mitte, Essen, Germany.
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de Cock L, Leblanc J, Kurtz JE. Les antiangiogéniques dans le cancer épithélial de l’ovaire : où en sommes-nous ? ONCOLOGIE 2014. [DOI: 10.1007/s10269-014-2404-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Aghajanian C, Goff B, Nycum LR, Wang Y, Husain A, Blank S. Independent radiologic review: bevacizumab in combination with gemcitabine and carboplatin in recurrent ovarian cancer. Gynecol Oncol 2014; 133:105-10. [PMID: 24508841 DOI: 10.1016/j.ygyno.2014.02.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Revised: 01/22/2014] [Accepted: 02/02/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE OCEANS, a randomized, placebo-controlled, phase III trial, found that adding bevacizumab to gemcitabine-carboplatin (GC) significantly improved investigator-determined progression-free survival (PFS) and objective response rate (ORR) in platinum-sensitive, recurrent ovarian cancer. To evaluate the reliability of assessment of progression and objective response per RECIST, radiologic and clinical data were assessed by an independent review committee (IRC). METHODS Radiologic images and clinical data were provided prospectively to the IRC for all randomized patients (N=484). Data were reviewed in a blinded fashion per RECIST (modified v1.0). PFS and ORR were analyzed based on the IRC assessment. Concordance between investigator- and IRC-assessed progression and objective response was assessed. RESULTS The IRC analysis demonstrated a statistically significant increase in PFS (hazard ratio [HR]=0.451; 95% confidence interval [CI]=0.351 to 0.580, p<0.0001) consistent with the benefit reported by investigators (HR=0.484; 95% CI=0.388 to 0.605, p<0.0001). The concordance rate, defined by agreement on progression status, was 74.2% overall, and comparable between treatment arms (bevacizumab, 75.2% vs. placebo, 73.1%). IRC-assessed ORR was significantly improved with bevacizumab (bevacizumab, 74.8% vs. placebo, 53.7%; p<0.0001), consistent with the investigator-assessed results. The concordance rate for objective response was 79.8% overall, and comparable between treatment arms (bevacizumab, 78.9% vs. placebo, 80.6%). CONCLUSIONS IRC-determined results were highly consistent with those determined by investigators, demonstrating that bevacizumab plus GC provides a significant improvement in PFS and ORR. These results suggest that investigators can reliably assess disease progression and objective response in recurrent ovarian cancer using RECIST, without the necessity of a full IRC review.
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Affiliation(s)
- Carol Aghajanian
- Memorial Sloan-Kettering Cancer Center, Gynecologic Medical Oncology Service, 300 East 66th Street, New York, NY 10065, USA; Weill Cornell Medical College, 445 East 69th Street, New York, NY 10021, USA.
| | - Barbara Goff
- University of Washington School of Medicine, Department of Obstetrics and Gynecology, Box 356460, Seattle, WA 98195, USA
| | - Lawrence R Nycum
- Novant Health Forsyth Medical Center, Division of Gynecologic Oncology, 3333 Silas Creek Pkwy, Winston-Salem, NC 27103, USA
| | - Yan Wang
- Genentech, Inc., Product Development, 1 DNA Way, South San Francisco, CA 94080, USA
| | - Amreen Husain
- Genentech, Inc., Product Development, 1 DNA Way, South San Francisco, CA 94080, USA
| | - Stephanie Blank
- New York University School of Medicine, Department of Obstetrics and Gynecology, 160 East 34th Street, New York, NY 10016, USA
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Abstract
Phase III trials of antiangiogenic drugs for metastatic breast cancer have either had only limited success, e.g. the monoclonal anti-VEGF antibody bevacizumab when used with various conventional chemotherapy regimens, or have failed altogether, e.g. the small molecule oral tyrosine kinase inhibitor (TKI) sunitinib. No phase III trial has yet demonstrated an overall survival benefit and the progression free survival (PFS) benefits, when attained with bevacizumab are short, with perhaps one exception. Together, these results call for a reappraisal of using antiangiogenic drugs for breast cancer and possible strategies to improve their efficacy. Among the reasons to help explain the limited benefits observed thus far include the possibility that angiogenesis may not be a major driver of breast cancer growth, compared to some other types of cancer; that acquired resistance may develop rapidly to VEGF-pathway targeting antiangiogenic drugs, in part due to angiogenic growth factor redundancy; that optimal chemotherapy regimens have not been used in conjunction with an antiangiogenic drug; and that antiangiogenic drugs may secondarily aggravate biologic aggressiveness of the tumors, thereby reducing their overall efficacy after inducing an initial benefit. Several possible strategies are discussed for improving the efficacy of antiangiogenic drugs, including combination with different chemotherapy regimens, e.g. long term and less toxic metronomic chemotherapy protocols; validation of predictive biomarkers to individualize patient therapy; development of improved preclinical therapy models, e.g. involving advanced metastatic breast cancer, and combination with other types of anti-cancer agents especially biologies such as trastuzumab for Her2-positive breast cancer. Reasons for the current concern regarding use of antiangiogenic drug treatments for early stage cancers, including breast cancer, are also discussed.
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Affiliation(s)
- Robert S Kerbel
- Sunnyhrook Research Institute, Dept of Molecular & Cellular Biology Research, Professor, Dept of Medical Biophysics, University of Toronto, Toronto, ON M4N 3M5, USA
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Trimble EL, Birrer MJ, Hoskins WJ, Marth C, Petryshyn R, Quinn M, Thomas GM, Kitchener HC, Aghajanian C, Alberts DS, Armstrong D, Brown J, Coleman RL, Colombo N, Eisenhauer E, Friedlander M, Fujiwara K, Hunsberger S, Kaye S, Ledermann JA, Lee S, Look K, Mannel R, McNeish IA, Minasian L, Oza A, Paul J, Poveda A, Pujade-Lauraine E, Schoenfeldt M, Swart AM, von Gruenigen V, Wenzel L. Current academic clinical trials in ovarian cancer: Gynecologic Cancer Intergroup and US National Cancer Institute Clinical Trials Planning Meeting, May 2009. Int J Gynecol Cancer 2011; 20:1290-8. [PMID: 21151709 DOI: 10.1111/igc.0b013e3181ee1c01] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To review the current status of large phase academic clinical trials for women with ovarian cancer, address cross-cutting issues, and identify promising areas for future collaboration. METHODS In May 2009, the Gynecologic Cancer Intergroup, which represents 19 Cooperative Groups conducting trials for women with gynecologic cancer, and the US National Cancer Institute convened a Clinical Trials Planning Meeting. RESULTS The topics covered included the impact of new developments in cancer biology upon molecular targets and novel agents, pharmacogenomics, advances in imaging, the potential benefit of diet and exercise to reduce the risk of recurrence, academic partnership with industry, statistical considerations for phases 2 and 3 trials, trial end points, and symptom benefit and health-related quality-of-life issues. The clinical trials discussed spanned the spectrum of ovarian cancer from initial diagnosis, staging, and cytoreductive surgery to consolidation chemotherapy, and treatment of recurrent disease. CONCLUSIONS Ongoing and effective collaboration with industry, government, and patients aims to ensure that the most important scientific questions can be answered rapidly. We encourage women with ovarian cancer and their oncologists to consider participation in the academic clinical trials conducted by the member groups of the Gynecologic Cancer Intergroup.
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Affiliation(s)
- Edward L Trimble
- National Cancer Institute, National Institutes of Health, Bethesda, MD 20892-7436, USA.
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Maintenance chemotherapy: an evolving and increasingly acceptable strategy in cancer management. Curr Oncol Rep 2011; 12:349-51. [PMID: 20711821 DOI: 10.1007/s11912-010-0121-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Individual randomized phase 3 trials and meta-analyses of previously published studies have provided support for the general concept of the clinical utility of extending the duration of antineoplastic drug therapy in an effort to prolong ("maintain") a favorable clinical state. This commentary briefly reviews data from several of these reports.
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Grisham RN, Berek J, Pfisterer J, Sabbatini P. Abagovomab: an anti-idiotypic CA-125 targeted immunotherapeutic agent for ovarian cancer. Immunotherapy 2011; 3:153-62. [PMID: 21322756 PMCID: PMC3221001 DOI: 10.2217/imt.10.100] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Ovarian cancer remains the leading cause of death due to gynecologic malignancies. Most patients present with advanced disease at the time of diagnosis. Although many have a good initial response to surgical debulking and platinum-based chemotherapy, relapse is common, with the eventual development of chemotherapy resistance. Innovative treatments are needed in the remission setting to prolong the disease-free interval or prevent recurrence. Abagovomab is a murine monoclonal anti-idiotypic antibody (molecular weight: 165-175 kDa) that functionally imitates the tumor-associated antigen, CA-125. It has been shown to be well tolerated and to induce a sustained immune response in initial Phase I and II clinical trials. An ongoing, double-blind, placebo-controlled, multicenter, Phase III trial (MIMOSA) completed its double-blind period in December 2010 and will compare abagovomab maintenance therapy to placebo, which will definitively determine the efficacy of this immunotherapeutic approach in patients with ovarian cancer.
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Affiliation(s)
- Rachel N Grisham
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Jonathan Berek
- Women's Cancer Center, Department of Obstetrics & Gynecology, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305, USA
| | - Jacobus Pfisterer
- Department of Gynecology, Staedtisches Klinikum Solingen, Gotenstr. 1, 42653 Solingen, Germany
| | - Paul Sabbatini
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
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Hess LM, Rong N, Monahan PO, Gupta P, Thomaskutty C, Matei D. Continued chemotherapy after complete response to primary therapy among women with advanced ovarian cancer: a meta-analysis. Cancer 2011; 116:5251-60. [PMID: 20665885 DOI: 10.1002/cncr.25487] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Ovarian cancer (OC) is associated with a >75% risk of recurrence after completion of primary therapy. Several clinical trials have explored the role of continued therapy after complete response to primary adjuvant therapy to reduce the risk of recurrence; however, these trials have largely been underpowered, leading to inconclusive results. METHODS A systematic search strategy was initiated to identify all clinical trials involving consolidation or maintenance therapy regimens for OC in first complete remission. A meta-analysis was conducted to evaluate toxicity and progression-free (PFS) and overall survival (OS). RESULTS There were 37 publications meeting all eligibility criteria, representing 20 consolidation and 9 maintenance therapy trials. Consolidation and maintenance therapies were associated with improved PFS (hazard ratio [HR], 0.79 [P = .003] and HR, 0.82 [P = .02], respectively) and OS (HR, 0.68 [P = .0008] and HR, 0.68 [P = .007], respectively). This relationship remained statistically significant when the analysis was limited to randomized trials and across other sensitivity analyses. CONCLUSIONS Although individual studies have not yet convincingly shown a survival advantage with maintenance chemotherapy in OC, this meta-analysis demonstrates that continued chemotherapy after completion of primary therapy for OC improves PFS and OS. Benefits are greatest in patients with advanced stage OC who reach complete clinical or pathologic response after primary therapy.
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Affiliation(s)
- Lisa M Hess
- Department of Public Health, Indiana University School of Medicine, Indianapolis, IN, USA.
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