# Bevacizumab and Tocotrienol in Recurrent Platinum-Resistant Ovarian Cancer, and the Role of HOXA9 as a Prognostic Biomarker

## TL;DR

This study explores the use of bevacizumab and tocotrienol in treating platinum-resistant ovarian cancer and investigates meth-HOXA9 as a potential biomarker for prognosis.

## Contribution

The study evaluates meth-HOXA9 as a prognostic biomarker in platinum-resistant ovarian cancer treated with bevacizumab and tocotrienol.

## Key findings

- The overall survival in the cohort was 7.5 months with a progression-free survival of 4 months.
- Baseline meth-HOXA9 levels did not show a statistically significant difference in overall survival.
- A few patients showed an extraordinary response in terms of progression-free survival.

## Abstract

Background/Objectives: Platinum resistant ovarian cancer represents a treatment challenge due to lack of efficient treatments and the absence of prognostic biomarkers. The circulating tumor DNA (ctDNA), methylated homebox A9 (meth-HOXA9), has been suggested as a biomarker for ovarian cancer, and might have a clinical impact in terms of predicting progression and supporting clinical decision making. Hence, this study investigated the prognostic value of meth-HOXA9 in platinum resistant recurrent ovarian cancer (PR-ROC) treated with bevacizumab and tocotrienol. Methods: Twenty patients with platin-resistant recurrent ovarian cancer were prospectively enrolled in this non-randomized phase II study. The treatment consisted of bevacizumab (Avastin) 10 mg/kg intravenously every three weeks and tocotrienol (Traptol) capsules 300 mg orally three times daily as a continuous treatment. The Level of meth-HOXA9 was measured at baseline and every three weeks. Results: The overall survival (OS) in the cohort was 7.5 months (95% CI 3.0–10.0), and the progression free survival was 4 months (95% CI 1.4–6.6). Comparing meth-HOXA9 ctDNA levels at baseline, there was no statistic significant difference in OS (p = 0.23). Conclusions: Treatment was well tolerated in this heavily pretreated cohort of PR-ROC patients with expected poor prognostic outcomes, with a few individuals showing extraordinary response in terms of progression free survival. The study was not powered to reproduce evidence of potential of meth-HOXA9 as a prognostic biomarker in PR-ROC.