Ovarian Cancer (First-Line Advanced) | DecisionBase | US/EU5/Asia Pacific | 2015

What Improvements Do Physicians and Payers Expect from Emerging Therapies?

Owing to a lack of specific symptoms, the majority of patients with ovarian cancer (CaO) present at an advanced stage of disease, when the tumor has spread outside the pelvis. Following initial debulking surgery, CaO patients with metastatic involvement are treated with the view of slowing disease progression and extending overall survival (OS). Current drug regimens for first-line advanced CaO include doublet chemotherapy combinations of platinum agents (cisplatin [Bristol-Myers Squibb’s Platinex, generics] or carboplatin [Bristol-Myers Squibb’s Paraplatin, generics]), with either a taxane (paclitaxel [Bristol-Myers Squibb’s Taxol, generics] or docetaxel [Sanofi’s Taxotere, generics]) or pegylated liposomal doxorubicin (PLD; Janssen Biotech’s Doxil/Caelyx). Bevacizumab (Roche/Genentech/Chugai’s Avastin), an inhibitor of vascular endothelial growth factor (VEGF) ligand and an inhibitor of angiogenesis, is the only targeted agent used in the first-line advanced setting for CaO; it is used in combination with chemotherapy and is continued as a monotherapy maintenance treatment. Bevacizumab was approved in Europe in December 2011 for first-line advanced CaO, and although the agent is not approved in the first-line setting in the United States, interviewed experts report off-label use. The emerging therapies considered in the report include targeted agents (i.e., olaparib [AstraZeneca’s Lynparza], trebananib [Amgen/Takeda], and nintedanib [Boehringer Ingelheim’s Vargatef]) and an immunotherapy (Sotio’s DCVAC/OvCa), which are being evaluated in combination with current chemotherapy. Commercial opportunity awaits emerging targeted agents that can provide greater survival benefits than the current standards of care and add minimal toxicities to the existing chemotherapy regimens used to treat first-line advanced CaO.