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Metronomic cyclophosphamide with Avastin for ovarian cancer

Posted Feb 10 2012 3:47pm

Patients with ovarian cancer that has recurred or progressed following prior therapies,  have unfavorable long-term outcomes with standard therapies. Although additional chemotherapy can be used to treat these patients, they often have minimal anti-cancer responses as well as side effects from treatment. Initial study of Avastin focused on this unfavourable group. Researchers. The previous trials included Avastin with metronomic cyclophosphamide and one with a taxane.  SInce tehn several retrospective reviews, small phase II trials and case reprots ahd been published, Thye generally conclude that this is a tolerable and effective combinaiton but more study is needed.

NCCN supports second line use of Avastin alone or in combination – on p. OV-D, 1. However, metronomic cyclophosphamide should be farther tested with Avastin before it is adapted for routine use.
There is an ongoing trial: Sequential Angiogenic Blockade for the Treatment of Recurrent Mullerian Malignancies, NCT00856180. The purpose of this study is to see if it is safe to give Avastin (bevacizumab) and Cyclophosphamide (cytoxan) together without causing serious side effects.

Perren T, Swart AM, Pfisterer J, et al: ICON7: A phase III randomized gynaecologic cancer intergroup trial of concurrent bevacizumab and chemotherapy followed by maintenance bevacizumab versus chemotherapy alone in women with newly diagnosed epithelial ovarian cancer, primary peritoneal cancer, or fallopian tube cancer. Program and abstracts of the 35th European Society for Medical Oncology (ESMO) Congress; October 8-12, 2010; Milan, Italy. Abstract LBA4.

Burger RA, Brady MF, Bookman MA, et al. Phase III trial of bevacizumab (BEV) in the primary treatment of advanced epithelial ovarian cancer (EOC), primary peritoneal cancer (PPC), or fallopian tube cancer (FTC): A Gynecologic Oncology Group study. J Clin Oncol. 2010;28:abstract LBA1, ASCO Annual Meeting Proceedings (Post-Meeting Edition). Available at: http://meeting.ascopubs.org/cgi/content/abstract/28/18_suppl/LBA1
Oncology. 2010;79(1-2):98-104. Epub 2010 Nov 15.
Bevacizumab plus low-dose metronomic oral cyclophosphamide in heavily pretreated patients with recurrent ovarian cancer.
Sánchez-Muñoz A, Mendiola C, Pérez-Ruiz E, Rodríguez-Sánchez CA, Jurado JM, Alonso-Carrión L, Ghanem I, de Velasco G, Quero-Blanco C, Alba E.

Burger R, Brady MF, Bookman MA, et al: Phase III trial of bevacizumab (BEV) in the primary treatment of advanced epithelial ovarian cancer (EOC), primary peritoneal cancer (PPC), or fallopian tube cancer (FTC): A Gynecologic Oncology Group study. 2010 ASCO Annual Meeting. Abstract LBA1. Presented June 6, 2010.

Cohn DE, Valmadre S, Resnick KE, et al. Bevacizumab and weekly taxane chemotherapy demonstrates activity in refractory ovarian cancer. Gynecologic Oncology. 2006;March 7;

 

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