罗氏（Roche）8月6日宣布，欧盟委员会（EC）批准安维汀（Avastin，通用名：bevacizumab，贝伐单抗）联合紫杉醇（paclitaxel）、拓扑替康（topotecan）或聚乙二醇化脂质体阿霉素（doxorubicin）化疗，用于铂耐药复发性卵巢癌女性患者的治疗。Avastin是首个获欧盟批准用于铂耐药复发性卵巢癌的生物药。此次获批，使欧洲铂耐药复发性卵巢癌患者群体在过去15年中获得了首个新的治疗选择。
Avastin的获批，是基于在铂耐药复发性卵巢癌患者中开展的III期AURELIA研究的积极数据。AURELIA是一项多中心、随机、开放标签III期研究，涉及361例既往接受过不超过2种抗癌疗法的铂耐药复发性上皮性卵巢、原发性腹膜或输卵管癌患者。研究中，患者随机分配至6个治疗组（紫杉醇、替康或脂质体阿霉素，有或无Avastin）。数据表明，Avastin联合化疗使疾病恶化风险降低了52%（无进展生存期PFS，平均PFS:6.7个月 vs 3.4个月，p＜0.001），达到了研究的主要终点。总生存期（OS）次要终点则未表现出统计学意义的显著改善（平均OS：16.7个月 vs 13.3个月，p＜0.174）。
AURELIA研究是证实Avastin联合化疗能显著改善卵巢癌无进展生存期（PFS）的第4个III期研究。在欧洲，欧盟于2011年批准Avastin用于晚期卵巢癌的一线治疗（基于关键III期GOG 0128和ICON7研究）、于2012年批准Avastin用于复发性铂敏感卵巢癌的治疗（基于关键III期OCEANS研究）。
在所有妇科癌症中，卵巢癌具有最高的死亡率。在欧盟，每年新增4.4万例卵巢癌患者，其中有许多患者可能已经到了晚期，在接受初始治疗后病情会复发。在治疗复发性卵巢癌时，接受最后一次含铂化疗与疾病复发之间的时间，被用于帮助确定下一线治疗中的化疗选择。如果患者在完成含铂化疗后的1-6个月内病情恶化，则称为铂耐药卵巢癌；若病情在6个月之后恶化，则称为铂敏感卵巢癌。在欧盟，接受初始治疗后病情复发的卵巢癌群体中，每年有四分之一（超过10000例）是铂耐药卵巢癌，这是卵巢癌中最难以治疗的类型。
关于安维汀（Avastin）：
Avastin（通用名：bevacizumab，贝伐单抗）是罗氏（Roche）旗下基因泰克（Genentech）开发的一种单克隆抗体，可特异性结合并抑制VEGF（血管内皮生长因子）的生物效应。VEGF（血管内皮生长因子）是肿瘤血管生成的关键驱动因素，而血管生成为肿瘤生长并扩散（转移）所需要。Avastin的精确作用方式使其能够与化疗和其它方式的抗癌治疗有效结合。Avastin可抑制肿瘤生长、延长生存期，且对化疗副作用的影响有限。
迄今为止，Avastin在欧洲获批的适应症包括：晚期乳腺癌、晚期结直肠癌、晚期非小细胞肺癌、晚期肾细胞癌、晚期卵巢癌；Avastin在美国获批的适应症包括：结直肠癌、非小细胞肺癌、肾细胞癌、复发性成胶质细胞瘤。
此外，Avastin已获全球110国家批准，用于卵巢癌的一线治疗。
英文原文：EU approves Roche's Avastin for platinum-resistant recurrent ovarian cancer
First new treatment option for women in Europe in more than 15 years for most difficult to treat form of ovarian cancer
Roche (SIX: RO, ROG; OTCQX: RHHBY) announced today that the European Commission (EU) approved the use of Avastin (bevacizumab) in combination with paclitaxel, topotecan, or pegylated liposomal doxorubicin chemotherapy as a treatment for women with recurrent ovarian cancer that is resistant to platinum-containing chemotherapy.
The EU approval was based on results of the phase III AURELIA study which involved women with recurrent, platinum-resistant ovarian cancer who received either chemotherapy or Avastin in combination with chemotherapy.1 Results showed that the addition of Avastin to chemotherapy gave a clinically meaningful benefit, nearly doubling the median progression free survival (PFS) from 3.4 months to 6.7 months (HR=0.38, p<0.0001).1,2
¡°European approval of Avastin for recurrent, platinum-resistant ovarian cancer is good news because Avastin can help women live longer without their cancer progressing, which is an important treatment goal in advanced disease,¡± said Sandra Horning, M.D., Roche¡ˉs Chief Medical Officer and Head, Global Product Development. ¡°Avastin is the first biologic medicine approved by the EU for women with this difficult to treat disease.¡±
Ovarian cancer has the highest mortality rate of all gynaecological cancers.3 Of the 44,000 women diagnosed each year in the European unio many will have advanced disease that will return after initial treatment.4-6 When treating recurrent ovarian cancer, the time between receiving the last dose of platinum-based chemotherapy and disease recurrence is used to help determine the choice of chemotherapy used in the next line of treatment. Patients are said to have ¡®platinum-resistant¡ˉ disease if their disease worsens between one and six months following completion of their platinum-based chemotherapy, and ¡®platinum-sensitive¡ˉ disease if it worsens more than six months after. A quarter of those who relapse after initial treatment, over 10,000 women a year in the European unio, will have platinum-resistant cancer, the most difficult to treat form of the disease.
This approval will enable the use of Avastin in combination with paclitaxel, topotecan, or pegylated liposomal doxorubicin for the treatment of women with platinum-resistant recurrent epithelial ovarian, fallopian tube, or primary peritoneal cancer who received no more than two prior chemotherapy regimens and who have not received prior therapy with Avastin or other VEGF inhibitors or VEGF receptor¨Ctargeted agents.
AURELIA is the fourth phase III study of Avastin in ovarian cancer to show that adding Avastin to chemotherapy significantly increased the time women with ovarian cancer lived without their disease worsening.1,7-9 In 2011, Avastin was approved in the EU as a front-line treatment for advanced ovarian cancer based on the pivotal GOG 0128 and ICON7 phase III studies. In 2012, Avastin was approved in the EU as a treatment for recurrent, platinum-sensitive ovarian cancer based on the results of the pivotal phase III OCEANS study.
AURELIA additional study results
AURELIA is a Roche-sponsored multicentre, randomised, open-label, two arm phase III study that was set-up in cooperation with the Group d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens (GINECO) and was conducted by the international network of the Gynecologic Cancer Intergroup (GCIG) and the pan-European Network of Gynaecological oncological Trial Groups (ENGOT). Study data from 361 women showed:
Women with recurrent, platinum-resistant ovarian cancer who received Avastin in combination with chemotherapy (paclitaxel, topotecan or pegylated liposomal doxorubicin) had a median overall survival of 16.6 months compared to 13.3 months for women treated with chemotherapy alone (HR=0.87, p=0.27).1
In addition, women who received Avastin in combination with chemotherapy had a significantly higher rate of tumour shrinkage (objective response rate, ORR) compared to women who received chemotherapy alone (28.2 percent versus 12.5 percent, p=0.0007).1
No new safety findings were observed in the AURELIA study and adverse events were consistent with those seen in previous trials of Avastin across tumour types for approved indications.1
about ovarian cancer
Ovarian cancer causes more deaths than any other gynaecologic cancer.3 It is the seventh most commonly diagnosed cancer in women worldwide, with an estimated 230,000 cases diagnosed around the world every year and there are approximately 150,000 deaths from the disease.3 In the EU, there are an estimated 44,000 cases of ovarian cancer every year, and nearly 30,000 women will die from the disease.4 Surgery to remove as much of the tumour as possible is a mainstay of treatment but unfortunately, the majority of patients are diagnosed with late stage disease (when the cancer has grown or spread) and they require further treatment.5,6,10 Ovarian cancer is associated with high concentrations of vascular endothelial growth factor (VEGF), a protein linked to tumour growth and spread.11 Studies have shown a correlation between a high concentration of VEGF and ascites development (excess fluid in the abdominal cavity), disease worsening, and a poorer prognosis in women with ovarian cancer.11 Avastin is designed to specifically target VEGF.
about Avastin ¨C mechanism of action
An independent blood supply is critical for a tumour to grow beyond a certain size (2mm) and spread (metastasise) to other parts of the body. Tumours develop their own blood supply in a process called angiogenesis by releasing vascular endothelial growth factor (VEGF) ¨C a key driver for tumour growth. Avastin is an antibody that precisely targets and inhibits VEGF. Precise VEGF inhibition by Avastin allows it to be combined effectively with a broad range of chemotherapies and other anti-cancer treatments with limited additional impact on the side effects of these therapies.
about Avastin ¨C over 10 years of transforming cancer care
With the initial approval in the USA for advanced colorectal cancer in 2004, Avastin became the first anti-angiogenic therapy made widely available for the treatment of patients with an advanced cancer.
Today, Avastin is continuing to transform cancer care through its proven survival benefit (overall survival and/or progression free survival) across several types of cancer. Avastin is approved in Europe for the treatment of advanced stages of breast cancer, colorectal cancer, non-small cell lung cancer, kidney cancer and ovarian cancer, and is available in the USA for the treatment of colorectal cancer, non-small cell lung cancer and kidney cancer. In addition, Avastin is approved in the U.S. and over 60 other countries worldwide for the treatment of patients with progressive glioblastoma following prior therapy. Avastin is approved in Japan for the treatment of the advanced stages of colorectal, non-small cell lung cancer, breast cancer, ovarian cancer and malignant glioma, including newly diagnosed glioblastoma.
Avastin has made anti-angiogenic therapy a fundamental pillar of cancer treatment today. Over 1.5 million patients have been treated with Avastin so far. A comprehensive clinical programme with more than 500 ongoing clinical trials is investigating the use of Avastin in over 50 tumour types.
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