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Daniele G, Raspagliesi F, Scambia G, Pisano C, Colombo N, Frezzini S, Tognon G, Artioli G, Gadducci A, Lauria R, Ferrero A, Cinieri S, De Censi A, Breda E, Scollo P, De Giorgi U, Lissoni AA, Katsaros D, Lorusso D, Salutari V, Cecere SC, Zaccarelli E, Nardin M, Bogani G, Distefano M, Greggi S, Piccirillo MC, Fossati R, Giannone G, Arenare L, Gallo C, Perrone F, Pignata S. Bevacizumab, carboplatin, and paclitaxel in the first line treatment of advanced ovarian cancer patients: the phase IV MITO-16A/MaNGO-OV2A study. Int J Gynecol Cancer 2021; 31:875-882. [PMID: 33931498 DOI: 10.1136/ijgc-2021-002434] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/30/2021] [Accepted: 03/31/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To explore the clinical and biological prognostic factors for advanced ovarian cancer patients receiving first-line treatment with carboplatin, paclitaxel, and bevacizumab. METHODS A multicenter, phase IV, single arm trial was performed. Patients with advanced (FIGO (International Federation of Gynecology and Obstetrics) stage IIIB-IV) or recurrent, previously untreated, ovarian cancer received carboplatin (AUC (area under the curve) 5), paclitaxel (175 mg/m2) plus bevacizumab (15 mg/kg) on day 1 for six 3-weekly cycles followed by bevacizumab single agent (15 mg/kg) until progression or unacceptable toxicity up to a maximum of 22 total cycles. Here we report the final analysis on the role of clinical prognostic factors. The study had 80% power with a two-tailed 0.01 α error to detect a 0.60 hazard ratio with a factor expressed in at least 20% of the population. Both progression-free and overall survival were used as endpoints. RESULTS From October 2012 to November 2014, 398 eligible patients were treated. After a median follow-up of 32.3 months (IQR 24.1-40.4), median progression-free survival was 20.8 months (95% CI 19.1 to 22.0) and median overall survival was 41.1 months (95% CI 39.1 to 43.5). Clinical factors significantly predicting progression-free and overall survival were performance status, stage, and residual disease after primary surgery. Neither baseline blood pressure/antihypertensive treatment nor the development of hypertension during bevacizumab were prognostic. There were two deaths possibly related to treatment, but no unexpected safety signal was reported. CONCLUSIONS Efficacy and safety of bevacizumab in combination with carboplatin and paclitaxel and as maintenance were comparable to previous data. Hypertension, either at baseline or developed during treatment, was not prognostic. Performance status, stage, and residual disease after primary surgery remain the most important clinical prognostic factors. TRIAL REGISTRATION NUMBER EudraCT 2012-003043-29; NCT01706120.
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Affiliation(s)
- Gennaro Daniele
- Unità Sperimentazioni Cliniche, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Italy.,Direzione Scientifica, Policlinico Universitario Agostino Gemelli, Roma, Italy
| | | | - Giovanni Scambia
- Dipartimento Scienze della Salute della Donna e del Bambino, Policlinico Universitario Agostino Gemelli, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Carmela Pisano
- Oncologia Clinica Sperimentale Uro-Ginecologica, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Italy
| | - Nicoletta Colombo
- Istituto Europeo di Oncologia IRCCS, and Dipartimento di Medicina e Chirurgia, Università degli Studi di Milano-Bicocca, Milano, Italy
| | - Simona Frezzini
- Oncologia Medica 2, Istituto Oncologico Veneto IRCCS, Padova, Italy
| | - Germana Tognon
- Divisione di Ostetricia e Ginecologia, ASST Spedali Civili di Brescia, Università degli Studi di Brescia, Brescia, Italy
| | - Grazia Artioli
- Oncologia ed Ematologia, U.L.S.S. 13, Mirano (VE), Italy.,Oncologia Medica, ULSS2 Marca Trevigiana, Treviso, Italy
| | - Angiolo Gadducci
- Dipartimento di Medicina Clinica e Sperimentale, UO Ginecologia e Ostetricia, Università degli Studi di Pisa Facolta di Medicina e Chirurgia, Pisa, Italy
| | - Rossella Lauria
- Oncologia Medica, Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II Scuola di Medicina e Chirurgia, Napoli, Italy
| | - Annamaria Ferrero
- Divisione Universitaria di Ginecologia e Ostetricia, Azienda Ospedaliera Ordine Mauriziano di Torino, Torino, Italy
| | - Saverio Cinieri
- Divisione di Oncologia Medica, Ospedale Antonio Perrino, Brindisi, Italy
| | | | - Enrico Breda
- Dipartimento di oncologia, Ospedale San Giovanni Calibita Fatebenefratelli, Roma, Italy
| | - Paolo Scollo
- Divisione di Ostetricia e Ginecologia, Azienda Ospedaliera Cannizzaro, Catania, Italy
| | - Ugo De Giorgi
- Oncologia Medica, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola (FC), Italy
| | | | - Dionyssios Katsaros
- Dipartimento di Scienze Chirurgiche, Ginecologia Oncologica, Ospedale Sant'Anna, Università di Torino, Torino, Italy
| | - Domenica Lorusso
- Chirurgia Ginecologica, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy.,Dipartimento Scienze della Salute della Donna e del Bambino, Policlinico Universitario Agostino Gemelli, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Vanda Salutari
- Dipartimento Scienze della Salute della Donna e del Bambino, Policlinico Universitario Agostino Gemelli, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Sabrina Chiara Cecere
- Oncologia Clinica Sperimentale Uro-Ginecologica, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Italy
| | - Eleonora Zaccarelli
- Istituto Europeo di Oncologia IRCCS, and Dipartimento di Medicina e Chirurgia, Università degli Studi di Milano-Bicocca, Milano, Italy
| | - Margherita Nardin
- Radiologia, Istituto Oncologico Veneto IRCCS, Università di Padova, Padova, Italy
| | - Giorgio Bogani
- Chirurgia Ginecologica, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Mariagrazia Distefano
- Dipartimento Scienze della Salute della Donna e del Bambino, Policlinico Universitario Agostino Gemelli, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Stefano Greggi
- Ginecologia Oncologica, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Italy
| | - Maria Carmela Piccirillo
- Unità Sperimentazioni Cliniche, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Italy
| | - Roldano Fossati
- Istituto di Ricerche Farmacologiche Mario Negri, Milano, Italy
| | - Gaia Giannone
- Dipartimento di Oncologia, Università degli Studi di Torino e Istituto di Candiolo, FPO - IRCCS, Torino, Italy
| | - Laura Arenare
- Unità Sperimentazioni Cliniche, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Italy
| | - Ciro Gallo
- Dipartimento di Salute Mentale e Fisica e Medicina Preventiva, Università degli Studi della Campania Luigi Vanvitelli, Napoli, Italy
| | - Francesco Perrone
- Unità Sperimentazioni Cliniche, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Italy
| | - Sandro Pignata
- Oncologia Clinica Sperimentale Uro-Ginecologica, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Italy
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Daniele G, Lorusso D, Scambia G, Cecere SC, Nicoletto MO, Breda E, Colombo N, Artioli G, Cannella L, Lo Re G, Raspagliesi F, Maltese G, Salutari V, Ferrandina G, Greggi S, Baldoni A, Bergamini A, Piccirillo MC, Tognon G, Floriani I, Signoriello S, Perrone F, Pignata S. Feasibility and outcome of interval debulking surgery (IDS) after carboplatin-paclitaxel-bevacizumab (CPB): A subgroup analysis of the MITO-16A-MaNGO OV2A phase 4 trial. Gynecol Oncol 2016; 144:256-259. [PMID: 27993479 DOI: 10.1016/j.ygyno.2016.12.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 12/07/2016] [Accepted: 12/10/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Few data are available on the outcome of surgery after a bevacizumab-containing regimen. The MITO 16A- MaNGO OV2A phase 4 trial evaluates the outcomes of first-line CPB in a clinical-practice-like setting. Here we present the results of the subgroup of patients undergoing IDS after neoadjuvant treatment or suboptimal primary surgery. METHODS 400 chemonaïve epithelial ovarian cancer patients, age≥18, ECOG PS 0-2 were eligible to receive C (AUC 5 d1, q21) plus P (175mg/m2 d1, q21) and B (15mg/kg d1 q21) for 6cycles followed by B maintenance until cycle 22nd. RESULTS 79 patients (20%) underwent IDS. Overall, 74 patients received at least one administration of B before IDS. Median age was 61.2, 70% of the patients had FIGO IIIC disease. The median number of cycles before IDS was 3 both for chemotherapy and bevacizumab respectively. A residual disease ≤1cm was achieved in 64 patients (86.5%). Four percent of the patients experienced fever and 4% required blood transfusion after surgery. Surgical wound infection and/or dehiscence, pelvic abscess, intestinal sub-occlusion and fistula were experienced by one patient each. CONCLUSIONS In the MITO16A-MaNGO OV2A phase 4 trial, combined chemotherapy and bevacizumab did not hamper IDS and the rate of perioperative complications was similar to what expected without bevacizumab. These data support the hypothesis that adding bevacizumab to first line chemotherapy for ovarian cancer might not be denied to patients for whom IDS is planned.
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Affiliation(s)
- Gennaro Daniele
- Clinical Trials Unit, Istituto Nazionale per lo Studio e la Cura dei Tumori "Fondazione Giovanni Pascale"- IRCCS, Naples, Italy
| | - Domenica Lorusso
- Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy
| | - Giovanni Scambia
- Division of Gynaecologic Oncology, Department of Obstetrics and Gynaecology, Catholic University of the Sacred Heart, Rome, Italy
| | - Sabrina C Cecere
- Division of Medical Oncology, Department of Uro-Gynaecological Oncology, Istituto Nazionale Tumori "Fondazione G. Pascale" - IRCCS, Naples, Italy
| | | | - Enrico Breda
- Medical Oncology Department, San Giovanni Calibita-Fatebenefratelli Hospital, Isola Tiberina, Rome, Italy
| | - Nicoletta Colombo
- Gynecology Department, European Institute of Oncology (IEO), Milan, Italy
| | | | - Lucia Cannella
- Department of Medical Oncology, G Rummo Hospital, Benevento, Italy
| | - Giovanni Lo Re
- Medical Oncology Department, Santa Maria degli Angeli Hospital, Pordenone, Italy
| | | | - Giuseppa Maltese
- Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy
| | - Vanda Salutari
- Division of Gynaecologic Oncology, Department of Obstetrics and Gynaecology, Catholic University of the Sacred Heart, Rome, Italy
| | - Gabriella Ferrandina
- Division of Gynaecologic Oncology, Department of Obstetrics and Gynaecology, Catholic University of the Sacred Heart, Rome, Italy
| | - Stefano Greggi
- Division of Medical Oncology, Department of Uro-Gynaecological Oncology, Istituto Nazionale Tumori "Fondazione G. Pascale" - IRCCS, Naples, Italy
| | - Alessandra Baldoni
- Medical Oncology Unit, Istituto Oncologico Veneto IOV-IRCCS, Padua, Italy
| | - Alice Bergamini
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria Carmela Piccirillo
- Clinical Trials Unit, Istituto Nazionale per lo Studio e la Cura dei Tumori "Fondazione Giovanni Pascale"- IRCCS, Naples, Italy
| | - Germana Tognon
- Obstetric and Gynaecology Azienda Ospedaliera "Spedali Civili", Brescia, Italy
| | - Irene Floriani
- Dipartimento di Oncologia, IRCCS Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | | | - Francesco Perrone
- Clinical Trials Unit, Istituto Nazionale per lo Studio e la Cura dei Tumori "Fondazione Giovanni Pascale"- IRCCS, Naples, Italy
| | - Sandro Pignata
- Division of Medical Oncology, Department of Uro-Gynaecological Oncology, Istituto Nazionale Tumori "Fondazione G. Pascale" - IRCCS, Naples, Italy.
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Graybill W, Sood AK, Monk BJ, Coleman RL. State of the science: Emerging therapeutic strategies for targeting angiogenesis in ovarian cancer. Gynecol Oncol 2015; 138:223-6. [PMID: 26166806 DOI: 10.1016/j.ygyno.2015.07.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Whitney Graybill
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Medical University of South Carolina, Charleston, SC, United States
| | - Anil K Sood
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States; Department of Cancer Biology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Bradley J Monk
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Creighton University, Phoenix, AZ, United States
| | - Robert L Coleman
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States.
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Yang X, Shen F, Hu W, Coleman RL, Sood AK. New ways to successfully target tumor vasculature in ovarian cancer. Curr Opin Obstet Gynecol 2015; 27:58-65. [PMID: 25502429 PMCID: PMC4529067 DOI: 10.1097/gco.0000000000000136] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW The aim of this article was to review the recent literature on potential therapeutic strategies for overcoming resistance to antivascular endothelial growth factor drugs in ovarian cancer. RECENT FINDINGS Although clinical benefits of antivascular endothelial growth factor therapy were observed in ovarian cancer treatment trials, this use yielded only modest improvement in progression-free survival and, with the exception of cediranib, no effect on overall survival. Adaptive resistance and escape from antiangiogenesis therapy is likely a multifactorial process, including induction of hypoxia, vascular modulators, and immune response. New drugs targeting the tumor vasculature or other components of the surrounding microenvironment have shown promising results. SUMMARY When to start and end antiangiogenesis therapy and the choice of optimal treatment combinations remain controversial. Further evaluation of personalized novel angiogenesis-based therapy is warranted. Defining the critical interaction of these agents and pathways and the appropriate predictive markers will become an increasingly important objective for effective treatment.
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Affiliation(s)
- Xiaoyun Yang
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Fangrong Shen
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Wei Hu
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Robert L. Coleman
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Anil K. Sood
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- Department of Cancer Biology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- Center for RNA Interference and Non-Coding RNAs, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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