Chemotherapy with or without bevacizumab for ovarian cancer, primary peritoneal cancer or fallopian tube cancer
Are there better ways to treat women who have ovarian, peritoneal or fallopian tube cancer?
What was this study about?
This trial aimed to find out whether giving a drug called bevacizumab (also known as Avastin) alongside and after chemotherapy can help women with ovarian, fallopian tube or peritoneal cancer.
Bevacizumab works by blocking the development of new blood vessels in the tumour and interfering with the tumour’s ability to grow and spread to other parts of the body. Women who took part in this trial were randomised into two groups. Doctors gave all women standard chemotherapy drugs (the drugs that are usually used to treat women with these cancers). One of the groups of women were given bevacizumab as well as these chemotherapy drugs. All of the women who took part in this trial were also asked about their quality of life.
What difference did this study make?
The first results from the ICON7 trial were announced in 2010. The results were positive, showing that combining bevacizumab with standard chemotherapy improves progression-free survival (time without disease worsening or coming back). The effect of bevacizumab was most striking after 1 year, when disease progression had occurred in 15% fewer women treated with bevacizumab than without bevacizumab. Overall, women in the trial who received bevacizumab experienced an average of 1.5 months of extra time without the disease worsening. This is, of course, a rather small average effect, but the benefit seemed to be more pronounced in women who had the highest chance of their disease coming back.
The ICON7 trial also aimed to find out whether women who receive bevacizumab live longer than those in the group receiving no bevacizumab. The preliminary overall survival results presented in 2010 showed no clear difference between the bevacizumab and no-bevacizumab groups. However, updated results in 2011 showed that the improvement in progression-free survival still existed and researchers also found that there was an improvement in overall survival (living longer) in the group of women treated with bevacizumab. From these results it also seemed as though patients most likely to have early disease progression (high-risk disease) have a more noticeable improvement in survival than women with lower-risk disease.
The final results of ICON7 were announced in 2013. Overall, the results showed that those in the group receiving bevacizumab did not live for longer than those in the group receiving no bevacizumab. However, for those patients with high-risk disease, who were most likely to have early disease progression, the results were positive and showed an improvement in overall survival of 4.8 months in the group who received bevacizumab. For futher details, a summary of the trial can be found here.
This is the second positive trial with bevacizumab in ovarian cancer. The results of ICON7 support the findings of an American trial of bevacizumab (GOG218) that were also announced in 2010, although the American trial used double the dose of drug compared to ICON7. Bevacizumab is the first new drug that has improved outcomes for women with untreated ovarian cancer in 17 years. Very recently, a third trial (OCEANS) has shown positive results with bevacizumab in ovarian cancer, this time in patients who have already received chemotherapy after surgery. Additionally, the AURELIA trial showed that bevacizumab was beneficial for patients who had previously received chemotherapy but whose cancer had returned. A summary for the AURELIA trial can be found here.
Type of study
Who funded the study?
This trial was funded by Roche Pharmaceutical. Bevacizumab was also supplied by Roche.
When did it take place?
Recruitment started in December 2006 and closed in February 2009. The final results were announced in 2013 and published in the Lancet Oncology in June 2015 (ICON7 manuscript).
A large sample collection programme ran alongside the ICON7 study and a number of exciting translational research projects involving these samples are currently ongoing.
Where did it take place?
The study took place in 263 hospitals across the UK, mainland Europe, Canada, Australia and New Zealand.
Who was included?
The trial recruited 1,528 women who had ovarian cancer, peritoneal cancer or fallopian tube cancer.