– Approval based on two large Phase III studies including GOG-0213
that showed a five month overall survival difference for women with
platinum-sensitive recurrent ovarian cancer on Avastin plus chemotherapy
compared to chemotherapy alone –
– In the United States, Avastin is now approved for nine distinct
uses across six different types of cancer –
SOUTH SAN FRANCISCO, Calif.–(BUSINESS WIRE)–Genentech, a member of the Roche Group (SIX: RO, ROG; OTCQX: RHHBY),
today announced that the U.S. Food and Drug Administration (FDA) has
approved Avastin® (bevacizumab), either in combination with
carboplatin and paclitaxel or in combination with carboplatin and
gemcitabine chemotherapy, followed by Avastin alone, for the treatment
of patients with platinum-sensitive recurrent epithelial ovarian,
fallopian tube or primary peritoneal cancer. Women are said to have a
‘platinum-sensitive’ form of the disease if a relapse occurs six months
or longer following the last treatment with a platinum-based
“With today’s approval of Avastin plus chemotherapy, women in the U.S.
with recurrent, platinum-sensitive ovarian cancer now have a treatment
option that showed a survival difference of more than five months
compared to chemotherapy alone in a clinical trial,” said Sandra
Horning, M.D., chief medical officer and head of Global Product
Development. “This approval was based in part on a Gynecologic Oncology
Group cooperative clinical trial and reinforces the importance of
partnerships with study groups to identify new treatment options for
people in need.”
“In the United States, ovarian cancer causes more deaths annually than
any other gynecologic cancer,” said David Barley, chief executive
officer, National Ovarian Cancer Coalition (NOCC). “This approval
demonstrates Genentech’s commitment to women with ovarian cancer, a
disease with signs and symptoms that too often go unrecognized.”
Avastin in combination with chemotherapy for platinum-sensitive
recurrent epithelial ovarian, fallopian tube or primary peritoneal
cancer was granted priority review, and today’s approval is based on
results from two randomized, controlled Phase III studies, GOG-0213 and
OCEANS. The GOG-0213 study demonstrated that adding Avastin to
chemotherapy showed an overall survival difference of five months
compared to chemotherapy alone (median OS: 42.6 months vs. 37.3 months;
Hazard Ratio (HR)=0.84, 95% CI: 0.69-1.01 and HR=0.82, 95% CI:
0.68-0.996, depending on stratification factor*). Both the GOG-0213 and
OCEANS studies demonstrated a significant improvement in the time women
lived without their disease getting worse (progression-free survival,
PFS). The GOG-0213 study showed that women lived a median of 3.4 months
longer without disease progression with the addition of Avastin to
chemotherapy compared to chemotherapy alone (median PFS: 13.8 months vs.
10.4 months; HR=0.61, 95% CI: 0.51-0.72). The OCEANS study showed that
Avastin in combination with chemotherapy significantly improved PFS
compared to placebo plus chemotherapy (median PFS: 12.4 months vs. 8.4
months; HR=0.46, 95% CI: 0.37-0.58; p<0.0001). Overall survival, one of
the secondary endpoints in the OCEANS study, was not significantly
improved with the addition of Avastin to chemotherapy (HR=0.95, 95% CI:
0.77-1.17). Adverse events in both studies were consistent with those
seen in previous trials of Avastin across tumor types for approved
indications, but also included fatigue, low white blood cell count with
fever, low sodium level in the blood, pain in extremity, low platelet
count, too much protein in the urine, high blood pressure and headache. (*refer
to details under GOG-0213 data table)
In November 2014, Avastin was approved in the United States for the
treatment of women with platinum-resistant recurrent epithelial ovarian,
fallopian tube or primary peritoneal cancer in combination with
paclitaxel, pegylated liposomal doxorubicin or topotecan chemotherapy.
Women are considered to have a ‘platinum-resistant’ form of the disease
if a relapse occurs less than six months after the last treatment with a
About the GOG-0213 and OCEANS Studies
GOG-0213 is an independent Phase III study sponsored by the National
Cancer Institute (NCI) and conducted by the Gynecologic Oncology Group
(GOG) that enrolled 673 women with platinum-sensitive recurrent
epithelial ovarian, fallopian tube or primary peritoneal cancer. The
primary endpoint of the study was to assess whether the addition of
Avastin to chemotherapy (carboplatin and paclitaxel) followed by
continued use of Avastin alone increased overall survival (OS) compared
to chemotherapy alone. Progression-free survival (PFS) and objective
response rate (ORR) were secondary endpoints in the GOG-0213 study.
|GOG-0213 Study Results|
|Primary Endpoint: Overall Survival (OS)|
|Median OS||42.6 months||37.3 months|
|Hazard Ratio (95% CI) (IVRS)1||0.84 (0.69, 1.01)|
|Hazard Ratio (95% CI) (eCRF)2||0.82 (0.68, 0.996)|
|Secondary Endpoint: Progression-Free Survival (PFS)|
|Median PFS||13.8 months||10.4 months|
|Hazard Ratio (95% CI)||0.61 (0.51, 0.72)|
|Secondary Endpoint: Objective Response Rate (ORR)|
Number of patients with
Grade 3 or 4 adverse events occurring at a higher incidence (≥2%)
in 325 patients treated with Avastin plus chemotherapy compared to
332 patients treated with chemotherapy alone were hypertension
(11.1% vs. 0.6%), fatigue (7.7% vs. 2.7%), febrile neutropenia (6.2%
vs. 2.7%), proteinuria (8.0% vs. 0.0%), abdominal pain (5.8% vs.
0.9%), hyponatremia (3.7% vs. 0.9%), headache (3.1% vs. 0.9%) and
pain in extremity (3.4% vs. 0.0%). No Grade ≥ 3 adverse events
occurred with a ≥ 2% higher frequency in the chemotherapy alone arm
compared to the Avastin plus chemotherapy arm. There were no Grade 5
adverse events occurring at a higher incidence (≥ 2%) in the Avastin
plus chemotherapy arm compared to the chemotherapy alone arm.
1 Hazard ratio was estimated from Cox proportional hazards
models stratified by the duration of treatment free-interval prior to
enrolling onto this study per IVRS (interactive voice response system)
and secondary surgical debulking status.
2 Hazard ratio was estimated from Cox proportional hazards
models stratified by the duration of platinum free-interval prior to
enrolling onto this study per eCRF (electronic case report form) and
secondary surgical debulking status.
OCEANS, a company sponsored trial, is a placebo-controlled, randomized,
multicenter Phase III study that evaluated the safety and efficacy of
Avastin, administered in combination with chemotherapy (carboplatin and
gemcitabine), in 484 women with platinum-sensitive recurrent epithelial
ovarian, fallopian tube or primary peritoneal cancer. The primary
endpoint of the study was PFS, as determined by the investigator using
Response Evaluation Criteria for Solid Tumors (RECIST). Secondary
endpoints included ORR, OS and safety.
|AVF4095g (OCEANS) Study Results|
Avastin + chemotherapy
Placebo + chemotherapy
|Primary Endpoint: Progression-Free Survival (PFS)|
|Median PFS||12.4 months||8.4 months|
|Hazard Ratio (95% CI) p-value||
0.46 (0.37, 0.58)
|Secondary Endpoint: Objective Response Rate (ORR)|
Grade 3 or 4 adverse events occurring at a higher incidence (≥ 2%)
in 247 patients treated with Avastin plus chemotherapy compared to
233 patients treated with placebo plus chemotherapy were
thrombocytopenia (40.1% vs. 33.9%), nausea (4.5% vs. 1.3%), fatigue
(6.5% vs. 4.3%), headache (3.6% vs. 0.9%), proteinuria (9.7% vs.
0.4%), dyspnea (4.5% vs. 1.7%), epistaxis (4.9% vs. 0.4%) and
hypertension (17.0% vs. 0.9%). Grade ≥ 3 anemia (16.2% vs. 18.9%)
and decreased white blood cell count (1.6% vs. 4.3%) occurred with a
≥ 2% higher frequency in the chemotherapy alone arm compared to the
Avastin plus chemotherapy arm. There were no Grade 5 adverse events
occurring at a higher incidence (≥ 2%) for the Avastin plus
chemotherapy arm compared to the placebo plus chemotherapy arm.
About Ovarian Cancer
Ovarian cancer causes more deaths than any other gynecologic cancer in
the United States. In 2016, about 22,200 women will be diagnosed with
ovarian cancer in the United States and about 14,200 will die from the
disease. Patients are said to have ‘platinum-sensitive’ disease if a
relapse occurs six months or longer following the last cycle of
platinum-based chemotherapy. About half of those who relapse after
initial treatment – over 8,000 women – will have platinum-sensitive
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Avastin is a prescription-only medicine that is a solution for
intravenous infusion. It is a biologic antibody designed to specifically
bind to a protein called vascular endothelial growth factor (VEGF) that
plays an important role throughout the lifecycle of the tumor to develop
and maintain blood vessels, a process known as angiogenesis. Avastin is
designed to interfere with the tumor blood supply by directly binding to
the VEGF protein to prevent interactions with receptors on blood vessel
cells. The tumor blood supply is thought to be critical to a tumor’s
ability to grow and spread in the body (metastasize).
Avastin is indicated for the first or second line treatment of
patients with metastatic colorectal cancer in combination with
intravenous 5 fluorouracil–based chemotherapy.
Avastin in combination with fluoropyrimidine-irinotecan or
fluoropyrimidine-oxaliplatin based chemotherapy is indicated for the
second line treatment of patients with metastatic colorectal cancer
who have progressed on a first line Avastin-containing regimen.
Avastin is not indicated for adjuvant treatment of colon cancer.
Avastin in combination with carboplatin and paclitaxel chemotherapy is
indicated for first line treatment of patients with unresectable,
locally advanced, recurrent or metastatic nonsquamous, non-small cell
Avastin is indicated for the treatment of metastatic renal cell
carcinoma in combination with interferon alfa.
Avastin in combination with paclitaxel and cisplatin or paclitaxel and
topotecan is indicated for the treatment of persistent, recurrent or
metastatic carcinoma of the cervix.
Avastin in combination with paclitaxel, pegylated liposomal
doxorubicin or topotecan, is approved to treat platinum-resistant
recurrent epithelial ovarian, fallopian tube or primary peritoneal
cancer (prOC) in women who received no more than
two prior chemotherapy treatments. Avastin, either in combination with
carboplatin and paclitaxel or with carboplatin and gemcitabine,
followed by Avastin alone, is approved for the treatment of patients
with platinum-sensitive recurrent epithelial ovarian, fallopian tube
or primary peritoneal cancer (psOC).
BOXED WARNINGS and Additional Important Safety Information
People receiving Avastin may experience side effects. In clinical
trials, some people treated with Avastin experienced serious and
sometimes fatal side effects, including:
Gastrointestinal (GI) perforation:
Treatment with Avastin can result in the development of a serious side
effect called GI perforation, which is the development of a hole in
the stomach, small intestine, or large intestine.
In clinical trials, this event occurred in more people who received
Avastin than in the comparison group (up to 3.2%).
In some cases, GI perforation resulted in fatality. Avastin therapy
should be permanently stopped if GI perforation occurs.
Surgery and wound healing problems:
Treatment with Avastin can lead to slow or incomplete wound healing
(for example, when a surgical incision has trouble healing or staying
closed). In some cases, this event resulted in fatality.
Surgery and wound healing problems occurred more often in people who
received Avastin than in the comparison group. In a controlled
clinical trial, in patients with metastatic colorectal cancer who had
surgery during the course of treatment, the incidence of wound healing
complications, including serious and fatal complications, was 15% for
patients who received Avastin and 4% for patients who did not receive
Avastin therapy should not be started for at least 28 days after
surgery and until the surgical wound is fully healed. The length of
time between stopping Avastin and having voluntary surgery without the
risk of wound healing problems following surgery has not been
Treatment with Avastin should be stopped at least 28 days before
voluntary surgery and in people with wound healing problems following
surgery that require medical treatment. Treatment with Avastin should
be stopped in patients with slow or incomplete wound healing.
Treatment with Avastin can result in serious or fatal bleeding,
including coughing up blood, bleeding in the stomach, vomiting of
blood, bleeding in the brain, nosebleeds and vaginal bleeding. These
events occurred up to five times more often in people who received
Avastin compared to patients who received only chemotherapy.
Across cancer types, 0.4% to 6.9% of people who received Avastin
experienced severe to fatal bleeding. People who have recently coughed
up blood (greater than or equal to a half teaspoon of red blood) or
have serious bleeding should not receive Avastin. Treatment with
Avastin should be permanently stopped if serious bleeding occurs.
Additional serious adverse events
In clinical trials for different cancer types, there were additional
serious and sometimes fatal side effects that occurred in more people
who received Avastin than in those in the comparison group.
The formation of an abnormal passage in the body (GI and non-GI
fistula formation) was seen in up to 2% of people in metastatic
colorectal cancer and ovarian cancer patients. In a study of patients
with cervical cancer, formation of an abnormal passage between the
vagina and GI tract was seen in 8.3% of people.
Severe to life-threatening stroke or heart problems were seen in 2.6%
Too much protein in the urine that led to kidney problems was seen in
≤1% of people.
Additional serious side effects that occurred in more people who
received Avastin than those in the comparison group included
- Severe to life-threatening blood clots (VTE), up to 10.6%
Severe to life-threatening high blood pressure, which was seen in
5% to 18% of people
Nervous system and vision disturbances (Posterior Reversible
Encephalopathy Syndrome), which was seen in less than 0.5% of
Infusion reactions with the first dose of Avastin were uncommon
and occurred in less than 3% of people, and severe reactions
occurred in 0.2% of people.
Avastin could cause a woman’s ovaries to stop working and may impair
her ability to have children. Avastin should not be used in ovarian
cancer patients who have evidence of recto-sigmoid involvement by
pelvic examination or bowel involvement on CT scan or clinical
symptoms of bowel obstruction.
Patients who are pregnant, think they are pregnant, or thinking of
becoming pregnant should talk with their doctor about the potential risk
of loss of the pregnancy or the potential risk of Avastin to the fetus
during and following Avastin therapy, and the need to continue an
effective birth control method for six months following the last dose of
Avastin. Avastin can cause fertility issues for women.
Women should be advised that breastfeeding while on Avastin may harm the
baby and is therefore not recommended.
Common side effects that occurred in more than 10% of people who
received Avastin for different cancer types, and at least twice the rate
of the comparison group, were nosebleeds, headache, high blood pressure,
inflammation of the nose, too much protein in the urine, taste change,
dry skin, rectal bleeding, tear production disorder, back pain and
inflammation of the skin (exfoliative dermatitis).
Across all trials, treatment with Avastin was permanently stopped in
8.4% to 21% of people because of side effects.
Report side effects to the FDA at (800) FDA-1088 or http://www.fda.gov/medwatch.
Report side effects to Genentech at (888) 835-2555.
For full Prescribing Information and Boxed WARNINGS on Avastin please
Founded 40 years ago, Genentech is a leading biotechnology company that
discovers, develops, manufactures and commercializes medicines to treat
patients with serious or life-threatening medical conditions. The
company, a member of the Roche Group, has headquarters in South San
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please visit http://www.gene.com.
Andrew Villani, 650-467-6800
Chris Campbell, 650-467-8466
Dahiya Ravindran, M.D., 650-491-5281
Karl Mahler, Ph.D., 011 41 61