The ICON7 trial evaluated the addition of bevacizumab to standard chemotherapy in ovarian cancer. In which subgroup of patients did bevacizumab maintenance provide the greatest progression-free survival benefit?

• A Early-stage (FIGO I–II) low-risk patients with complete debulking
• B Patients with BRCA1 germline mutation regardless of stage
• C Mucinous histological subtype patients
• D High-risk patients with FIGO stage III with residual disease >1 cm or FIGO stage IV ✓

Explanation

The ICON7 trial (Perren et al., NEJM 2011) randomised women with ovarian cancer to carboplatin/paclitaxel ± bevacizumab (concurrent and maintenance). Overall PFS benefit was modest, but a pre-specified high-risk subgroup analysis (FIGO stage III with >1 cm residual disease, or stage IV) showed significant improvement in both PFS and overall survival with bevacizumab. Early-stage completely debulked patients did not derive meaningful benefit. BRCA mutation status was not the primary stratification factor in ICON7 (that was the subject of SOLO-1 and PAOLA-1 for olaparib). This high-risk subgroup finding influenced approval of bevacizumab maintenance in advanced ovarian cancer.

Reference: Shaw's Textbook of Gynaecology, 17th ed.

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