Neoadjuvant Therapy in Advanced Ovarian Cancer With Avastin

NCT ID: NCT01847677

Last Updated: 2020-04-01

Basic Information

• Recruitment Status: TERMINATED
• Clinical Phase: PHASE2
• Total Enrollment: 71 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2013-05-06
• Study Completion Date: 2019-05-17

Brief Summary

Recently results have shown that Bevacizumab is active both in monotherapy and in combination therapy in patients with ovarian cancer. One of our objectives is to evaluate whether the addition of neoadjuvant bevacizumab improves the response and whether this affects the evolution of patients.

Detailed Description

Epithelial ovarian cancer (OC) is the fourth leading cause of cancer death in women, after lung, breast and colon cancer, and it represents the most common cause of death from gynaecological malignancies. The high mortality associated with OC is due to the lack of screening tests that enable an early diagnosis, thus the majority of patients are diagnosed at advanced stages of the disease when the chances of a cure are very limited. In fact, the 5-year overall survival (OS) rate for stage III-IV OC does not exceed 20-30% in many series. The standard treatment for advanced OC is maximal cytoreductive surgery (or debulking) followed by the administration of 6 cycles of adjuvant chemotherapy with carboplatin and paclitaxel.

In recent years, a number of studies have been carried out with antiangiogenic drugs. Specifically, bevacizumab, an anti-VEGF monoclonal antibody, has been shown to be active both in monotherapy and combination therapy in patients with OC that have received multiple previous lines of chemotherapy.

One of the objectives is to evaluate whether the addition of neoadjuvant bevacizumab improves the response and whether this affects the evolution of patients.

Conditions

Cancer, Ovarian

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: NONE

Study Groups

Paclitaxel & Carboplatin

1. Preoperative treatment Cycle 1 to 4 (4 cycles every 3 weeks of chemotherapy pre-surgery)

• Carboplatin AUC 6 i.v. first day
• Paclitaxel 175 mg/m2 i.v. first day

2. Surgery

3. Post-Operative treatment

Cycle 5 to 7 (3 cycles every 3 weeks of chemotherapy post-surgery):

• Carboplatin AUC 6 i.v. first day
• Paclitaxel 175 mg/m2 i.v. first day
• Bevacizumab 15 mg/Kg i.v. first day1

When the chemotherapy treatment is completed, the patient will continue with maintenance bevacizumab until 15 months length treatment.

Group Type: ACTIVE_COMPARATOR

Paclitaxel

Intervention Type: DRUG

Carboplatin

Intervention Type: DRUG

Paclitaxel & Carboplatin & Bevacizumab

4 cycles every 3 weeks (at least 3 Bevacizumab neoadjuvant cycles): Carboplatin AUC 6 i.v. first day Paclitaxel 175 mg/m2 i.v. first day Bevacizumab 15 mg/Kg i.v. first day.

b) Surgery Ovarian cancer surgery should be performed according to FIGO guidelines.

c) Postoperative treatment

Both arms:

Cycle 5 to 7 (3 cycles every 3 weeks of chemotherapy post-surgery):

Carboplatin AUC 6 i.v. first day Paclitaxel 175 mg/m2 i.v. first day Bevacizumab 15 mg/Kg i.v. first day.

When the chemotherapy treatment is completed, the patient will continue with maintenance bevacizumab until 15 months length treatment.

Group Type: EXPERIMENTAL

Bevacizumab

Intervention Type: DRUG

Paclitaxel

Intervention Type: DRUG

Carboplatin

Intervention Type: DRUG

Interventions

Bevacizumab

Intervention Type: DRUG

Paclitaxel

Intervention Type: DRUG

Carboplatin

Intervention Type: DRUG

Other Intervention Names

Avastin; Taxol; Paraplatin

Eligibility Criteria

Inclusion Criteria

1. Women over 18 years old

2. Obtained informed consent, in writing and signed

3. Histological confirmation of primary peritoneal carcinoma or fallopian tube carcinoma

4. Planned interval debulking surgery

5. ECOG:0 to 2

6. Life expectancy >12 weeks

Exclusion Criteria

1. Non-epithelial ovarian cancer, including malignant mixed Müllerian tumors.

2. Borderline ovarian tumors.

3. Administration of intraperitoneal chemotherapy planned.

4. Previous systemic anti-tumor treatment against ovarian cancer.

5. Intestinal obstruction or sub-occlusion, intestinal infiltration shown by CT scan or rectosigmoid infiltration in gynaecological examination.

6. Uncontrolled hypertension.

7. Any previous radiotherapy: abdomen or pelvis.

8. Major traumatic injuries in the 4 weeks prior to the first potential dose of bevacizumab.

9. History or clinical suspicion of brain metastases or spinal cord compression.

10. History or evidence of central nervous system (CNS) disorders, unless properly treated with standard medical treatment.

11. Cerebrovascular accident (CVA), transient ischemic attack (TIA) or subarachnoid haemorrhage (SAH) in the 6 months prior to randomization.

12. Fertile women of childbearing age who are not willing to use effective contraception during the study and at least 6 months after the study.

13. Women that are breastfeeding or pregnant.

14. Prior exposure to mouse CA-125 antibody.

15. Treatment with any other experimental product, or participation in another clinical trial within 30 days prior to inclusion.

16. Malignant tumors other than ovarian cancer within the 5 years prior to randomisation, with the exception of cervical carcinoma in situ treated correctly and/or basal-cell carcinoma.

17. Known hypersensitivity to bevacizumab or any of its excipients (including Cremophor).

18. Non-healing wound, active peptic ulcer or bone fracture. Patients with healing incised granulomas by secondary intention, with no evidence of fascial dehiscence or infection can be included, but they require three weeks of wound control.

19. History or evidence of bleeding or thrombotic diathesis

20. Current or recent continued use of aspirin > 325 mg / day (within 10 days prior to randomization)

21. Current or recent use (within 10 days before the first cycle of treatment) of full doses of anticoagulants or thrombolytics administered orally or parenterally for therapeutic purposes (except for vascular permeability, in which case the INR should be kept below 1.5).

22. Clinically significant cardiovascular disease, including:

• Myocardial infarction or unstable angina (≤ 6 months before randomization)
• Congestive heart failure (CHF) class ≥ II of the NYHA (New York Heart Association)
• Poorly controlled cardiac arrhythmia despite medication (may include patients with atrial fibrillation with controlled frequency)
• Peripheral vascular disease ≥ grade 3 (i.e. symptomatic and interfering with activities or daily living [ADL] needing repair or review)

23. Pre-existing sensory or motor neuropathy, ≥ grade 2

24. Demonstration of any other neurological or metabolic dysfunction involving a reasonable suspicion of the existence of a disease or condition that contraindicates the use of an experimental drug, or that involves an increased risk to the patient of treatment-related complications

25. No medical or psychiatric illness that may impede the performance of a systemic or surgical treatment

26. Laboratory:

Inadequate bone marrow function:

• ANC: <1.5 x 109/l
• platelet count <100 x 109/l
• Hb <9 g/dl. (Patients may be transfused)

Inadequate coagulation parameters: Activated partial thromboplastin time (APTT) >1.5 x ULN or INR >1.5

Inadequate liver function, defined as:

• Serum (total) bilirubin >1.5 x the upper limit of normal (ULN) for the institution
• AST & ALT > 2.5 x ULN (> 5 x ULN in patients with liver metastases) or alkaline phosphatase > 2.5 x ULN (or > 5 x ULN in case of liver metastases or > 10 x ULN in case of bone metastases).

Inadequate renal function, defined as:

• Serum creatinine >2.0 mg/dl or >177 mol/l
• Urine dipstick for proteinuria >2+
• Patients with 2+ proteinuria on baseline dipstick analysis should undergo a 24-hour urine collection and must demonstrate ≤1g of protein in their 24-hour urine collection

• Minimum Eligible Age: 18 Years
• Eligible Sex: FEMALE
• Accepts Healthy Volunteers: No

Sponsors

Roche Pharma AG

INDUSTRY

Sponsor Role: collaborator

Grupo Español de Investigación en Cáncer de Ovario

OTHER

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

Yolanda García, MD

Role: STUDY_CHAIR

C.S Parc Taulí

Locations

Hospital Germans Trias i Pujol

Badalona, , Spain

Hospital Clínic

Barcelona, , Spain

Hospital Sant Pau

Barcelona, , Spain

H. Reina Sofia

Córdoba, , Spain

ICO Girona

Girona, , Spain

ICO Hospitalet

Hospitalet Del Llobregat, , Spain

Hospital 12 de Octubre

Madrid, , Spain

Hospital Clínico San Carlos

Madrid, , Spain

Hospital Universitario Morales Meseguer

Murcia, , Spain

Hospital Son Llatzer

Palma Mallorca, , Spain

Parc Taulí

Sabadell, , Spain

Hospital Marqués de Valdecilla

Santander, , Spain

Hospital La Fe

Valencia, Valencia, Spain

Countries

Spain

References

Gaitskell K, Rogozinska 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 Apr 18;4(4):CD007930. doi: 10.1002/14651858.CD007930.pub3.

Reference Type: DERIVED

PMID: 37185961 (View on PubMed)

Other Identifiers

2012-003883-31

Identifier Type: EUDRACT_NUMBER

Identifier Source: secondary_id

GEICO-1205

Identifier Type: -

Identifier Source: org_study_id