Pembrolizumab in combination with bevacizumab and oral metronomic cyclophosphamide showed clinical activity in patients with recurrent epithelial ovarian cancer, according to the results of an open-label phase II trial (LBA4) presented at the 2019 Society of Gynecologic Oncology (SGO) 50th Annual Meeting on Women’s Cancer, held March 16–19 in Honolulu, Hawaii. “With these epithelial ovarian cancers, once it’s recurred, we don’t have as many options,” Eloise Chapman-Davis, MD, a gynecologic oncologist at Weill Cornell Medicine and NewYork-Presbyterian, told Cancer Network. Given the need for more treatment options, she said that the clinical benefit seen with the pembrolizumab combination in this trial is “very interesting and exciting.” The phase II trial (ClinicalTrials.gov identifier: NCT02853318) included a safety lead-in cohort of 5 patients and ultimately enrolled 40 women with recurrent epithelial ovarian, fallopian tube, or primary peritoneal cancer. All patients received pembrolizumab 200 mg in combination with bevacizumab 15 mg/kg every 3 weeks and oral cyclophosphamide 50 mg every day. The scientific rationale behind this three-drug combination is that by using an anti-VEGF inhibitor, lymphocyte trafficking will become improved and dendritic cell function restored. With the addition of cyclophosphamide, the circulating regulatory T cells will become depleted while simultaneously restoring the cytotoxic potential of T cells and natural killer cells. Chapman-Davis commended this rationale, saying, “They are pretty much manipulating immune cells with Avastin [bevacizumab] plus cyclophosphamide as a way to help increase the efficacy of the Keytruda [pembrolizumab].”
Source: Cancer Network
