Abstract
This study aimed to determine the real-world, long-term prognostic impacts, and adverse effects (AEs) of bevacizumab (BEV) in Asian patients with ovarian/tubal/peritoneal cancers. We retrospectively reviewed the medical records of consecutive patients with ovarian/tubal/peritoneal cancer on front-line chemotherapy with or without BEV (Cohort 1) and those who relapsed following chemotherapy and/or BEV (Cohort 2) between 2011 and 2018 in a tertiary medical centre. Patient characteristics, BEV dosages, clinical outcomes, and AEs were analyzed. Hazard ratios for disease progression and death were analyzed using a cox proportional regression model. Benefits of BEV used throughout triweekly, in terms of improved progression-free survival (PFS) and overall survival (OS), were observed at a dosage of 7.5–15 mg/kg among advanced-stage Cohort 1 patients. A progression-free interval of <6 months was the strongest predictor of disease progression and death in advanced-stage patients. BEV throughout and optimal cytoreduction were independent predictors of reduced disease progression. No prognostic advantage was observed between serous and clear cell histologies when BEV was added. Moreover, BEV resulted in improved OS in Cohort 2 patients, especially in the platinum-sensitive subgroup. Most patients had a front-line BEV dosage <10 mg/kg per cycle with <10 treatment cycles. Low rates and grades of BEV-related AEs were observed in both cohorts. BEV used throughout effectively extended PFS and OS in advanced-stage patients with ovarian/tubal/peritoneal cancer. Patients with platinum-sensitive carcinoma, treated with BEV, had a significant improvement in OS and extended PFS. Therefore, BEV can safely be added to chemotherapy for ovarian/tubal/peritoneal cancers.
Highlights
Epithelial ovarian cancer (EOC) is the leading cause of death among gynecological cancers in many countries [1,2,3]
A total of 147 (38.6%) were classified as having Federation of Gynecology and Obstetrics (FIGO) stages I–II and 234 (61.4%) as having stages III–IV; 116 (30.4%) patients were in the high-risk subgroup
In a multivariate-adjusted model, progression-free interval (PFI)
Summary
Epithelial ovarian cancer (EOC) is the leading cause of death among gynecological cancers in many countries [1,2,3]. Most patients with chemotherapy-sensitive disease develop chemotherapy-resistant relapse after undergoing several lines of therapy. Bevacizumab (BEV) can improve overall response rates in front-line or relapse therapy settings [5, 6]. Front-line chemotherapy with BEV throughout improved progression-free survival (PFS) in the GOG-218 [7] and ICON7 [8] trials and prolonged overall survival (OS) in GOG-218 stage IV and ICON7-defined high-risk patients [9, 10]. 52 and 39% reductions in the risk of progression or death by adding BEV to chemotherapy were observed in platinumsensitive recurrent EOC in the OCEANS [11] and GOG-213 [12] trials, respectively. A 52% reduction in the risk of progression or death was seen in platinum-resistant recurrent EOC in AURELIA [13]. The secondary endpoint in extending OS was not achieved [9, 11,12,13]
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