Dr. Mirza on the Rationale for the AVANOVA Trial in Recurrent Ovarian Cancer

Mansoor Raza Mirza, MD, chief oncologist in the Department of Oncology in Rigshospitalet, Copenhagen University Hospital, Denmark, discusses the rationale for the phase II AVANOVA study in patients with platinum-sensitive recurrent ovarian cancer.

The study, which looked at the chemotherapy-free combination of niraparib (Zejula) and bevacizumab (Avastin), more than doubled progression-free survival compared with niraparib alone, according to data presented at the 2019 ASCO Annual Meeting. While the emergence of PARP inhibitors has changed the landscape, Mirza says, it has brought forth new questions, including whether patients need chemotherapy at all. The other question is if antiangiogenic agents, immuno-oncology agents, and PARP inhibitors can be combined to increase efficacy.

The rationale to combine a VEGF antibody with a PARP inhibitor is that a drug like bevacizumab will induce hypoxia, causing an increase in homologous recombination deficiency, which boosts response to PARP inhibition. A phase I study confirmed the tolerability and efficacy of 300 mg of niraparib with 15 mg/kg of bevacizumab every 3 weeks.