The real MVP.

Top Line: Verdict is still out on the MVP in the systemic management of advanced ovarian cancer because it sure ain’t intraperitoneal chemo.
The Study: In 2011 initial reporting of the landmark GOG-0218 trial first established that the addition of bevacizumab to standard chemo prolongs progression-free survival (PFS). As a reminder, it randomized over 1800 women with incompletely-resected stage III-IV ovarian cancer to one of three (strictly intravenous) arms: [1] good ole carbo/Taxol q3 weeks x 6, [2] same with conconcurrent bev, [3] same with concurrent and maintenance (x1 year) bev. For all the haters of PFS analyses with no clear benefit in actual survival or even quality of life, we now have the final reporting of GOG-0218. Spoiler: it comes with no trophies. At a median follow-up of over 8.5 years, the (intended) primary endpoint of median overall survival (OS) was a wash across arms at 41-43 months, as was cancer-specific survival, as was OS across myriad subset analyses including cross-over, BRCA and CD31 status, and clinical risk. The only group to eek out a win were those with stage IV disease, among whom OS was improved from 33-34 → 44 months in arm [3].
TBL: You’re still never wrong in GYN tumor board with an answer of carbo/Taxol, the real MVP since circa 2000. | Tewari, J Clin Oncol 2019


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