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ORIGINAL ARTICLE
Year : 2014  |  Volume : 51  |  Issue : 7  |  Page : 92-94
 

Bevacizumab combined with chemotherapy in the treatment of recurrence or platinum-refractory ovarian cancer: A retrospective study of 37 cases


1 Department of Gynaecology and Obstetrics, Tianjin Hospital, Tianjin 300211, China
2 Department of Gynecological Oncology, Beijing Cancer Hospital, Beijing 100142, China

Date of Web Publication27-Mar-2015

Correspondence Address:
Y Li
Department of Gynaecology and Obstetrics, Tianjin Hospital, Tianjin 300211
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-509X.154079

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 » Abstract 

Background: Ovarian cancer was one of the most diagnostic cancers for women and leading cause of death from gynecologic cancer. Most of the cases were at advanced stage when diagnosed. Platinum-based regimen was considered as the firs-line chemotherapy treatment modality. But most of the cases developed recurrence or resistance to platinum. The aim of this retrospective study was to evaluate the activity and toxicity of bevacizumab combined with chemotherapy in the treatment of recurrence or platinum-refractory ovarian cancer. Materials and Methods: Totally, 37 ovarian cancer patients with complete data who treated with bevacizumab combined with chemotherapy were reviewed from the databases of Beijing Cancer hospital and included in this retrospective study. All included patients received >1 cycle of bevacizumab based combination therapy with eligible for the efficacy and toxicity assessments. The objective response rate (ORR) and toxicity were recorded and evaluated according to the Response Evaluation Criteria in Solid Tumors (RECIST) National Cancer Institute's Common Toxicity Criteria. Results: The ORR and disease control rate were 32.4% and 54.1% respectively by the RECIST criteria and 43.2%, 67.6% by CA125 criteria. The median progression-free survival for the 37 cases was 5.4 months with its range of 2.3-11.2 months. The two complete response patens had longest disease-free survival interval with one for 10.0 months and another for 11.2 months. The total grade III-IV hematologic toxicity and nonhematologic toxicity were 8.1% and 21.6% respectively. Conclusions: With acceptable toxicity and relative well clinical activity, the bevacizumab combined chemotherapy can be a potential treatment modality for the recurrent or platinum-refractory ovarian cancer.


Keywords: Bevacizumab, chemotherapy, efficacy, ovarian cancer, platinum-refractory, toxicity


How to cite this article:
Li Y, Yang Y, Shang Y M, Zheng H. Bevacizumab combined with chemotherapy in the treatment of recurrence or platinum-refractory ovarian cancer: A retrospective study of 37 cases. Indian J Cancer 2014;51, Suppl S3:92-4

How to cite this URL:
Li Y, Yang Y, Shang Y M, Zheng H. Bevacizumab combined with chemotherapy in the treatment of recurrence or platinum-refractory ovarian cancer: A retrospective study of 37 cases. Indian J Cancer [serial online] 2014 [cited 2020 Aug 12];51, Suppl S3:92-4. Available from: http://www.indianjcancer.com/text.asp?2014/51/7/92/154079



 » Introduction Top


Ovarian cancer was one of the most diagnostic cancers for women and leading cause of death from gynecologic cancer. It was reported about 75% cases of ovarian cancer were at advanced stage when diagnosis. [1] Most of the cases with ovarian cancer can reach complete response (CR) after initial multiple modality treatment. But >50% of the patients relapse or recurrent finally with the resistance for chemotherapy regimen or disease progression. [2] Recently, several prospective randomized controlled trials have demonstrated bevacizumab combined with chemotherapy can improve the prognosis of patients with ovarian cancer. [3],[4] We retrospectively analyzed 37 ovarian patients treated with bevacizumab combined chemotherapy in Beijing Cancer Hospital and reported the results.


 » Materials and Methods Top


Patients

We reviewed the databases of Beijing Cancer Hospital and included 37 ovarian cancer cases with complete data who treated with bevacizumab combined with chemotherapy. All included patients received >1 cycle of bevacizumab based combination therapy with eligible for the efficacy and toxicity assessments. The median age of the 37 patients was 52.6 with its range of 26-66 years old. The major pathology type for the 37 cases was serous papillary adenocarcinoma (89.2%) followed by transitional cell carcinoma (5.4%) and mixed adenocarcinoma (5.4%). The detailed characteristics are demonstrated in [Table 1].
Table 1: The demographic and general characteristics of the 37 patients

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Treatment modality

Bevacizumab was given 7.5 mg/kg + 0.9% Nacl intravenous drip 60 min 1 h prior or after the chemotherapy agents with 1 time/3 weeks. The chemotherapy agents were paclitaxel, ifosfamide, gemcitabine or pharmorubicin. All the patients included in this retrospective study had at least 4 weeks of nonchemotherapy interval.

Efficacy and toxicity evaluation

Patients with measurable disease were evaluated by the Response Evaluation Criteria in Solid Tumors (RECIST). [5] We also calculated the response rates by CA125 levels based on a modification of the Rustin criteria. [6] CR: CA125 (<35U/mL) maintained for at least 4 weeks; partial response (PR): About 50% reduction in CA125 maintained for more 4 weeks; progressive disease: At least a 25% increase in the serum CA125 level for at least 4 weeks; stable disease (SD): Patients who did not meet the above criteria were considered to be SD. Time to progression was measured from initiation of treatment until disease progression or death. Toxicity was evaluated according to the National Cancer Institute's Common Toxicity Criteria. [7]


 » Results Top


Objective response

The objective response rate (ORR) and disease control rate (DCR) for bevacizumab combined chemotherapy in the treatment of recurrence or platinum-refractory ovarian cancer were 32.4% and 54.1% respectively by the RECIST criteria. The ORR and DCR were 43.2% and 67.6% by CA125 criteria. The detailed response data are shown in [Table 2].
Table 2: The short‑term efficacy for the bevacizumab combined chemotherapy

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Progression free survival

The median progression-free survival (PFS) for the 37 cases was 5.4 months with its range of 2.3-11.2 months. The two CR patients had longest PFS interval with one for 10.0 months and another for 11.2 months [Figure 1].
Figure 1: The progression-free survival curve for the 37 patients

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Toxicity

The treatment regimen cycle was 2-8 with its median cycle of 4. The main toxicity of bevacizumab combined with chemotherapy in the treatment of recurrence or platinum-refractory ovarian cancer were grade I-II neutrocytopenia and thrombocytopenia with their incidence of 43.2% and 16.2% respectively. The main nonhematologic toxicity was grade I-II nausea and vomiting, diarrhea, hypertension and hemorrhage with their incidence rate of 32.4%, 16.2%, 10.8% and 10.8%. The total grade III-IV hematologic toxicity and nonhematologic toxicity were 8.1% and 21.6% respectively. The detailed data for toxicity are shown in [Table 3].
Table 3: The hematologic and nonhematologic toxicity for the include 37 cases (n (%))

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 » Discussion Top


In year 2012, ovarian cancer occurred in 239,000 women and led to 152,000 deaths worldwide. [8] This made it the seventh most common cancer and the eighth most common cause of death from malignant carcinoma. Most of the ovarian cancer patients can reach CR after initial multiple modality treatment. But >50% of the patients relapse or recurrent finally with the resistance for chemotherapy regimen or disease progression. [2] For recurrence or platinum-refractory disease, the NCCN guideline for ovarian cancer recommended single nonplatinum-based agents such as docetaxel, gemcitabine, liposomal and topotecan. Recently, several well-designed prospective randomized controlled trials evaluated the bevacizumab combined with chemotherapy in the treatment of ovarian cancer. It was believed that bevacizumab can improve PFS in women with ovarian cancer. The benefits with respect to both progression-free and overall survival were greater among those at high risk for disease progression. [9]

Bevacizumab is a recombinant humanized monoclonal antibody that blocks angiogenesis by inhibiting vascular endothelial growth factor. [10] It was approved by the U.S. Food and Drug Administration for certain metastatic cancers.

In our retrospective study, we reviewed and included 37 recurrence or platinum-resistance ovarian cancer patients. All of the 37 cases received bevacizumab combined another chemotherapy agent (paclitaxel, ifosfamide, gemcitabine or pharmorubicin). The ORR DCR was 32.4% and 54.1% respectively by the RECIST criteria and 43.2%, 67.6% by CA125 criteria. The median PFS was 5.4 months with its range of 2.3-11.2 months. The two CR patens had longest disease-free survival interval with one for 10.0 months and another for 11.2 months. The total grade III-IV hematologic toxicity and nonhematologic toxicity were 8.1% and 21.6% respectively.


 » Conclusion Top


Combination bevacizumab and chemotherapy demonstrates clinically promising in the treatment of recurrence or platinum-resistance ovarian cancer. But the response duration was relative short.

 
 » References Top

1.
Jemal A, Siegel R, Xu J, Ward E. Cancer statistics, 2010. CA Cancer J Clin 2010;60:277-300.  Back to cited text no. 1
    
2.
Ozols RF. Systemic therapy for ovarian cancer: Current status and new treatments. Semin Oncol 2006;33 2 Suppl 6:S3-11.  Back to cited text no. 2
    
3.
Aghajanian C, Blank SV, Goff BA, Judson PL, Teneriello MG, Husain A, et al. OCEANS: A randomized, double-blind, placebo-controlled phase III trial of chemotherapy with or without bevacizumab in patients with platinum-sensitive recurrent epithelial ovarian, primary peritoneal, or fallopian tube cancer. J Clin Oncol 2012;30:2039-45.  Back to cited text no. 3
    
4.
Akers SN, Riebandt G, Miller A, Groman A, Odunsi K, Lele S. Bevacizumab for the treatment of recurrent ovarian cancer: A retrospective cohort study. Eur J Gynaecol Oncol 2013;34:113-9.  Back to cited text no. 4
    
5.
Agrawal A, Purandare N, Shah S, Puranik A, Banavali S, Rangarajan V. Response assessment in metronomic chemotherapy: RECIST or PERCIST? Indian J Nucl Med 2014;29:74-80.  Back to cited text no. 5
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6.
Guppy AE, Nelstrop AE, Foster T, Agarwal R, Seckl MJ, Rustin GJ. A phase II study of sequential carboplatin, paclitaxel and topotecan in patients with previously untreated advanced ovarian cancer. Br J Cancer 2004;90:810-4.  Back to cited text no. 6
    
7.
Basch E, Reeve BB, Mitchell SA, Clauser SB, Minasian LM, Dueck AC, et al. Development of the National Cancer Institute′s patient-reported outcomes version of the common terminology criteria for adverse events (PRO-CTCAE). J Natl Cancer Inst 2014;106:1-11.  Back to cited text no. 7
    
8.
Siegel R, Naishadham D, Jemal A. Cancer statistics, 2012. CA Cancer J Clin 2012;62:10-29.  Back to cited text no. 8
    
9.
Perren TJ, Swart AM, Pfisterer J, Ledermann JA, Pujade-Lauraine E, Kristensen G, et al. A phase 3 trial of bevacizumab in ovarian cancer. N Engl J Med 2011;365:2484-96.  Back to cited text no. 9
    
10.
Los M, Roodhart JM, Voest EE. Target practice: Lessons from phase III trials with bevacizumab and vatalanib in the treatment of advanced colorectal cancer. Oncologist 2007;12:443-50.  Back to cited text no. 10
    


    Figures

  [Figure 1]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]

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