Ovarian Cancer Studies Creating Debate & Promise

Ovarian Cancer Studies Creating Debate & Promise

Jonathan S. Berek, MD, MMedSc, FASCO

Jun 30, 2010

Two studies recently presented at ASCO’s Annual Meeting have been an ongoing topic of discussion and debate for those of us who take care of women with ovarian cancer and those in the field of gynecologic oncology. The first research study of note is the phase III Gynecologic Oncology Group (GOG 218) trial presented at the ASCO Plenary Session by Dr. Robert Burger. The study demonstrates that adding bevacizumab (Avastin®) concurrent with primary carboplatin and paclitaxel chemotherapy and continuing the drug as a maintenance treatment improved progression-free survival (PFS) in women with advanced ovarian cancers compared to the standard arm of carboplatin and paclitaxel. However, it remains to be determined if the PFS gain of only 3.8 months is “meaningful to patients.” Dr. Elizabeth Eisenhauer, who discussed the data at the Plenary Session, raised this issue, the additional toxicity, and the cost-effectiveness of this approach.

The potential benefit of bevacizumab in the primary treatment of ovarian cancer issue will require more follow-up and more data, especially the results of a 2-arm prospective randomized trial (ICON7), which is being conducted in Europe. The trial data will be presented at the IGCS Meeting in Prague this October, and I am sure that we will be debating what is a “clinical meaningful” measurement. We plan to run a follow-up piece in which ASCO members debate the results of the GOG and ICON7 studies in an upcoming issue of ASCO Connection. Stay tuned…

Another very provocative study is the ovarian cancer screening program headed by Karen Lu, MD, and Bob Bast, MD, which was also presented at this year’s Annual Meeting. Using serial CA-125 levels and transvaginal ultrasonography, the authors presented their screening results in postmenopausal women in the general population, excluding those who have a very high risk of ovarian cancer, i.e., those with BRCA1-2 mutations.

They concluded that using a ROCA (risk of ovarian cancer algorithm) produces very few false-positive results. In addition, they identified three early stage invasive ovarian cancers, and two borderline tumors. Because these tumors could have an indolent growth rate and the study is not randomized, it is not clear if detection of these cancers will improve survival. Before drawing a conclusion regarding the definitive efficacy of this screening approach and methodology in the general population, we need to await the results of the very large randomized trial, the UKCTOCS (United Kingdom Collaborative Trial of Ovarian Cancer Screening), directed by Dr. Usha Menon and Dr. Ian Jacob. This fully accrued randomized trial of 200,000 women uses mortality as an end-point, and the mature follow-up data will be available in 2014. 


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