Recurrent ovarian cancer (rOC) responds well to anti-angiogenic therapy with bevacizumab in combination with chemotherapy; however, information on tyrosine kinase inhibitors following progression on maintenance of bevacizumab is lacking. Patients with rOC in the first year of bevacizumab maintenance therapy were randomly assigned to receive either regular weekly paclitaxel 80 mg/m2 weekly paclitaxel 65 mg/m2 with pazopanib 600-800 mg daily in the phase II TAPAZ study. The primary objective was the proportion of patients who remained progression-free (PFS) after 4 months. About 116 patients were treated after being randomly assigned; 79 received combination therapy, while 37 received paclitaxel alone. The average length of time people were followed up was 13.1 months. The 4-month progression-free survival rates (61% [95% CI, 51-73%] with the combination against 68% [95% CI, 54-85%] with paclitaxel alone) and median progression-free survival times (4.9 [95% CI, 4.1-6.1] versus 5.8 [95% CI, 4.8-7.4] months) were similar between the 2 therapy groups (13.6 versus 12.9 months, respectively). More patients experienced grade 3/4 toxicities (87% vs. 70%), and more patients discontinued paclitaxel because of severe side effects (22% vs. 11%) with the combination. In 44% of patients, toxicity caused them to stop taking pazopanib, most frequently due to GI and cardiovascular problems. 2 deaths occurred during therapy, both in the combo group (pulmonary embolism and gastrointestinal perforation). At month 4, there was a statistically significant and clinically relevant decline in the combination arm compared to paclitaxel alone in patient-reported outcomes, especially for abdominal/gastrointestinal symptoms. While adding pazopanib to paclitaxel did not improve efficacy, it increased toxicity and limited chemotherapeutic delivery in rOC that progressed while on maintenance bevacizumab.
Source: sciencedirect.com/science/article/pii/S0090825822004267
