Chicago, Illinois—Adding nintedanib to neoadjuvant chemotherapy has been shown to increase toxicity and compromise chemotherapy efficacy, in turn reducing survival in patients with advanced epithelial ovarian cancer, according to data presented at the 2019 ASCO Annual Meeting.

“Nintedanib, an oral inhibitor of VEGF-FGF-PDGF receptors, has been shown to prolong progression-free survival (PFS) when added to adjuvant chemotherapy after primary surgery,” according to Gwénael Ferron, MD, GINECO and Institut Claudius Regaud, Toulouse, France, and colleagues, whose CHIVA trial sought to determine the role of nintedanib when used in combination with neoadjuvant chemotherapy.

From January 2013 through May 2015, a total of 188 chemotherapy-naïve patients with unresectable, FIGO stage IIIC-IV, advanced epithelial ovarian cancer were enrolled in CHIVA. These patients were randomized in a 2:1 ratio to receive 3 to 4 cycles of carboplatin and paclitaxel before undergoing interval debulking surgery (IDS) followed by 2 to 3 cycles of carboplatin and paclitaxel for a total of 6 cycles, plus nintedanib 200 mg (arm A; n = 124) or placebo (arm B; n = 64) twice daily and 3 times weekly on days 2 through 21 during cycles 1, 2, 5, and 6, and as maintenance therapy for up to 2 years.

The primary end point of the study was PFS.

The median PFS was 14.4 months for arm A (95% CI, 12.2-15.4) and 16.8 (95% CI, 13.3-21.4) for arm B (hazard ratio [HR], 1.50; P = .02), and the median OS was 37.7 months (95% CI, 29.8-41.0) and 44.1 months (95% CI, 32.7 to not reached), respectively (HR, 1.54; P = .053).

There were more toxic events in arm A than in arm B (grade 3-4 adverse events: 92% vs 71%, respectively); rates of increased early treatment discontinuation before the third cycle (14.5 vs 6.2%) and carboplatin and paclitaxel dose reduction (12% vs 0%), respectively, were also greater in arm A than in arm B.

Of note, patients in arm A had inferior RECIST overall response rates to pre-IDS therapy compared with those in arm B (35.1% vs 55.9%, respectively). In addition, IDS was significantly less common in arm A (58.1%) than in arm B (76.6%).

Patients who did undergo IDS, however, had similar cytoreduction rates (76%) and peri/postoperative complication rates (11.2%), regardless of treatment arm.

“The addition of nintedanib to NACT [neoadjuvant chemotherapy] increases toxicity and compromise chemotherapy efficacy leading to a reduced rate of IDS and worse PFS and OS for advanced EOC [epithelial ovarian cancer] patient,” Dr Ferron et al concluded.—Hina Khaliq

Ferron G, De Rauglaudre G, Chevalier A, et al. Impact of adding nintedanib to neoadjuvant chemotherapy (NACT) for advanced epithelial ovarian cancer (EOC) patients: The CHIVA double-blind randomized phase II GINECO study. Presented at: the 2019 ASCO Annual Meeting; May 31-June 4, 2019; Chicago, IL. Abstract 5512.