Anti-angiogenesis therapy with bevacizumab for patients with ovarian granulosa cell tumors

Abstract

Objective Ovarian granulosa cell tumors tend to respond poorly to chemotherapy. We examined the clinical efficacy of bevacizumab with or without concurrent chemotherapy and evaluated the angiogenic characteristics of these patients' tumors. Methods We conducted a retrospective review of all patients seen at our institution from February 2004 to October 2008 who received bevacizumab for ovarian sex cord-stromal tumors. We performed immunohistochemical staining for vascular endothelial growth factor (VEGF) and CD31 when tissue was available; microvessel density was measured based on CD31 staining. Clinical data were abstracted from a chart review. Results We identified 8 patients who were treated with bevacizumab; 7 had adult granulosa cell tumors and one had a juvenile granulosa cell tumor. All patients had recurrent disease and had been previously treated with cytotoxic chemotherapy (median 3.5 regimens; range, 1–6). One patient had a complete clinical response to bevacizumab therapy, 2 patients had a partial response, 2 patients had stable disease, and 3 patients' disease progressed, yielding a response rate of 38% and a clinical benefit rate of 63%. The median progression-free survival was 7.2 months and overall survival was not reached at a median follow-up of 23.6 months after initiating bevacizumab. VEGF overexpression and microvessel density were associated with poor outcome but sample size was too small to calculate statistical significance. Conclusions Anti-VEGF therapy is highly effective in patients with granulosa cell tumors. Based on our observations, a prospective trial has been initiated using single-agent bevacizumab in patients with recurrent ovarian sex cord-stromal tumors.