Complete remission of ovarian cancer induced intractable malignant ascites with intraperitoneal bevacizumab. Immunological observations and a literature review

Abstract

Malignant ascites resistant to conventional drugs frequently affects ovarian cancer patients at the end of life. Here we report the case of a patient who benefited from complete resolution of ascites after low dose intraperitoneal administration of bevacizumab. Immunological analyses showed an initial increase in proportion and function of CD8(+) effector T cells and a reduction of circulating T(reg) cells. A review of the current literature regarding bevacizumab in ovarian cancer is reported. Bevacizumab has shown a high efficacy in the treatment of ovarian cancer. Intraperitoneal administration induces an immune activation and appears promising in the treatment of malignant ascites.

Intraperitoneal vascular endothelial growth factor burden in peritoneal surface malignancies treated with curative intent: The first step before intraperitoneal anti-vascular endothelial growth factor treatment?

“…Kobold et al suggested the possibility of using IP anti-VEGF in the palliative treatment of malignant ascites [14]. A few studies have reported the effectiveness of IP bevacizumab in treating symptomatic malignant ascites, especially in ovarian cancer [19][20][21][22], with improved quality of life and reduced paracentesis. This treatment has been proposed only in palliative care, and complete response versus ascites has been reported [19], suggesting the efficacy of IP administration.…”

“…A few studies have reported the effectiveness of IP bevacizumab in treating symptomatic malignant ascites, especially in ovarian cancer [19][20][21][22], with improved quality of life and reduced paracentesis. This treatment has been proposed only in palliative care, and complete response versus ascites has been reported [19], suggesting the efficacy of IP administration. In the curative therapeutic strategy for PSM, a new treatment combination must be developed to increase local control.…”

Extraperitoneal Metastases From Recurrent Ovarian Cancer

“…Kobold et al 12 reported that the therapeutic effect of intraperitoneal cisplatin was potentiated by BEV in a mouse model. Bellati et al 13 reported that the use of intraperitoneal BEV was associated with an increase in the proportion and function of CD8 effector T cells, and a reduction in circulating T(reg) cells, as well as resolution of malignant ascites in women with recurrent ovarian cancer. Similar therapeutic effects in humans have been reported elsewhere.…”

Immune Therapy for Ovarian Cancer: Promise and Pitfalls

“…Notable in this regard is bevacizumab, an anti-vascular endothelial growth factor antibody now shown to effect clinical benefit in OC as both a single agent and in combination with other treatments [122], but which could also have substantial immune properties, including increasing interferon-γ production and inhibiting Treg generation. Sorafenib, a multi-tyrosine kinase inhibitor useful in OC likewise can inhibit Treg generation [102].…”