Combination treatment improves recurrence and survival in ovarian cancer

A new combination of medications for treatment of recurrent ovarian cancer showed improved response rates, increased the rate of tumor shrinkage, and prolonged the time until cancers recurred. In addition, this treatment showed a trend in improving survival.

Trebananib is a peptide-Fc fusion protein or peptibody that targets angiogenesis, the growth of new blood vessels to cancerous tumors. Trebananib inhibits the binding of both angiopoietin 1 and 2 to the Tie2 receptor.

This is a different mechanism of action than other anti-angiogenesis agents, which inhibit vascular endothelial growth factor (VEGF). Class-specific adverse events associated with anti-VEGF therapy include hypertension, proteinuria, wound-healing complications, thrombotic events, and gastrointestinal perforations.

Trebananib did not increase the risk of hypertension or bowel perforation in patients, but still had an impact on tumor shrinkage and delay in cancer progression.

TRINOVA-1 was a randomized, prospective phase III clinical trial that added trebananib or placebo to standard chemotherapy (weekly paclitaxel) in more than 900 women with recurrent ovarian cancer from multiple international sites.

Median progression-free survival was longer in the trebananib group (7.2 months) than in the placebo group (5.4 months). Trebananib was associated with more adverse event-related treatment discontinuations (77 patients, 17%) than placebo (27 patients, 6%). In addition, patients in the trebananib group had a higher incidence of edema (294 patients, 64%) than patients in the placebo group (127 patients, 28%).

"This is an exciting new targeted medication for the treatment of recurrent ovarian cancer. Recurrent ovarian cancer is almost always fatal and new treatments are needed desperately," said Bradley J. Monk MD, director of the Division of Gynecologic Oncology at the University of Arizona Cancer Center in Phoenix, Arizona. "TRINOVA-1 showed that angiogenesis is a complex process in oncology. New targets like angiopoietin 1 and 2 will allow us to inhibit the growth of new blood vessels more effectively. The growth of new blood vessels is necessary for tumor growth, metastasis, and progression. If we can stop cancers from growing by choking off their blood supply, we can help our patients feel better and live longer."

This study was published in Lancet Oncology (2014; doi:10.1016/S1470-2045(14)70244-X). 

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