Outcomes and prognoses of patients with ovarian cancer using bevacizumab: 6-year experience in a tertiary care hospital of northern Taiwan

Abstract

PurposeBevacizumab (BEV) has been used for ovarian cancer (OC) for years in Taiwan, but the associated data related to outcome is scant. This retrospective study reviewed patients with OC treated with BEV and analyzed their results.Patients and methodsAll patients with OC treated with BEV from 2009 to 2015 in the Linkou branch of Chang Gung Memorial Hospital in Northern Taiwan were included. According to the means of administration, the patients were classified into 6 groups as follows: A—BEV plus chemotherapy (C/T) for initial platinum-resistant (PR) recurrent OC, B—BEV plus C/T for initial platinum-sensitive (PS) recurrent OC, C—BEV alone for recurrent OC, D—BEV plus 1st adjuvant C/T, E—BEV plus neoadjuvant C/T, and F—intraperitoneal (IP) BEV. Progression-free survival (PFS), overall survival (OS), hazard ratios (HRs), overall response rate (ORR), and mean number of BEV cycles were analyzed for groups A to E. Clinical improvement of ascites was assessed for group F.ResultsA comparison of early use (only one round of prior C/T) versus late use (multiple rounds of prior C/T) in patients of groups A and B showed a superior PFS (8.27 vs. 3.67, p = 0.037) in the early use group. No significant differences were found between groups A and B (PFS: 4.24 vs. 4.17 months, p = 0.690; OS: 10.06 vs. 9.93 months, p = 0.819; mean BEV cycles: 4.63 vs. 5.0 p = 0.992; ORR: 48.1% vs. 53.5%, p = 0.425). Comparing the response and non-response subgroups of patients in groups A and B, a better outcome was associated with endometrioid type cell (HR = 0.28, p = 0.008), good ECOG performance status (HR = 0.51, p = 0.005), and lack of ascites (HR = 0.67, p = 0.004). Comparing group C with groups A plus B, the BEV alone group had a poorer PFS (1.02 VS. 4.19, p = 0.04) and OS (1.42 VS. 9.99 p = 0.001) than the BEV plus C/T group. In group F, a good clinical benefit rate (85.6%) of ascites improvement was noted. Two patients had grade 5 gastrointestinal bleeding and venous/arterial thromboembolic events after administration of BEV. Grade 3 neutropenia and thrombocytopenia occurred more frequently in our study.ConclusionEarly use of BEV combined with chemotherapy had a significant benefit in PFS for patients with recurrent OC. BEV plus chemotherapy was better than BEV alone for recurrent OC. In addition, IP BEV was helpful for improving clinical ascites.

CD133 Act as an Essential Marker in Ovarian Carcinogenesis

“…However, direct causality is still not proven between them and OC (Tsilidis et al, 2011). Various factors, including atypical clinical symptoms, insufficient early detection modalities, late-onset diagnosis, chemoresistance, recurrence, and metastatic spread, lead to high mortality of ovarian cancer (Burges and Schmalfeldt, 2011;Chen et al, 2017;Klapdor et al, 2017).…”

Characterization of stem cell and cancer stem cell populations in ovary and ovarian tumors

“…While constituting only 3% of the cancer cases affecting women, ovarian cancer is a fatal malady due to its unpredictable prognosis, poor refractory outcome, onco-therapeutic resistance, metastatic spread and ultimate relapse with no signs of improvement in patient survival to date [ 1 ]. In recent years, existence of various cancer stem cells (CSCs) in ovarian tumor, as well as in ascites from patients with ovarian cancer have been reported as a cause of tumor relapse and recurrence, thus imposing a clinical problem [ 2 – 4 ].…”

Maximum Tolerated Dose and Anti-Tumor Activity of Intraperitoneal Cantrixil (TRX-E-002-1) in Patients with Persistent or Recurrent Ovarian Cancer, Fallopian Tube Cancer, or Primary Peritoneal Cancer: Phase I Study Results

“…In a Phase III trial, IP cisplatin (40 mg/m 2 ) plus bevacizumab (300 mg), every 2 weeks for 6 weeks, was superior to the same dose of IP cisplatin alone (ORR 90.32 vs. 59.26%, p < 0.05), and resulted in significantly reduced VEGF and CA-125 levels in ascites fluid [35]. Early data suggestive of a role for IP bevacizumab in the palliation of malignant ascites in recurrent ovarian cancer [36,37] are supported by clinical experience demonstrating improved ascites with IP-administered bevacizumab (5 mg/kg) in 6/7 (85.6%) patients [38]. The Phase II REZOLVE study has demonstrated that IP bevacizumab (5 mg/kg), administered following paracentesis, increased the median time of paracentesis-free intervals by 4.3-fold compared to the time between paracenteses before entry into the study [39].…”