Addition of bevacizumab to neoadjuvant chemotherapy for Stage IV ovarian serous adenocarcinoma with multiple lymph node metastases: a case report

A 50-year-old female patient was diagnosed with Stage IV ovarian serous adenocarcinoma with multiple lymph node metastases. The CA-125 level normalized after four cycles of neoadjuvant chemotherapy (NACT) using paclitaxel, nedaplatin, and bevacizumab (BEV) before surgery. A positron emission tomography-computed tomography (PET-CT) scan showed significantly reduced bilateral adnexal masses after NACT fluorodeoxyglucose (FDG) metabolism in multiple lymph nodes was inhibited significantly, and the number and sites of metastatic lesions were decreased. The patient underwent optimal cytoreductive surgery. Chemotherapy was continued after surgery and image-guided radiation therapy (IGRT) (40 Gy) was applied for the remaining lymph nodes in the pelvic cavity and cervicothoracic region. No sign of recurrence has been observed in this patient nine months after surgery. The patient achieved a satisfactory outcome and no serious side effects were observed. Therefore, addition of BEV to NACT is a new method for the pre-operative treatment of advanced ovarian cancer.

Advanced ovarian cancer; Neoadjuvant chemotherapy; Bevacizumab.

[1] Dyer M., Richardson J., Robertson J., Adam J.: “NICE guidance on bevacizumab in combination with paclitaxel and carboplatin for the first-line treatment of advanced ovarian cancer”. Lancet Oncol., 2013, 14, 689.

[2] Mahner S., Woelber L., Eulenburg C., Schwarz J., Carney W., Jaenicke F., et al. TIMP-1 and VEGF-165 serum concentration during first- line therapy of ovarian cancer patients. BMC Cancer, 2010, 10, 139.

[3] Cooper B.C., Ritchie J.M., Broghammer C.L., Coffin J., Sorosky J.I., Buller R.E., et al.: “Preoperative serum vascular endothelial growth factor levels: significance in ovarian cancer”. Clin. Cancer Res., 2002, 8, 3193.

[4] Gadducci A., Ferdeghini M., Fanucchi A., Annicchiarico C., Ciampi B., Prontera C., et al.: “Serum preoperative vascular endothelial growth factor (VEGF) in epithelial ovarian cancer: relationship with prognostic variables and clinical outcome”. Anticancer Res., 1999, 19, 1401.

[5] Mabuchi S., Terai Y., Morishige K., Tanabe-Kimura A., Sasaki H., Kanemura M., et al.: “Maintenance treatment with bevacizumab prolongs survival in an in vivo ovarian cancer model”. Clin. Cancer Res., 2008, 14, 7781.

[6] Burger R.A., Brady M.F., Bookman M.A., Fleming G.F., Monk B.J., Huang H., et al.: “Incorporation of bevacizumab in the primary treatment of ovarian cancer”. N. Engl. J. Med., 2011, 365, 2473.

[7] Perren T.J., Swart A.M., Pfisterer J., Ledermann J.A., Pujade-Lauraine E., Kristensen G., et al.: “A phase 3 trial of bevacizumab in ovarian cancer. N. Engl. J. Med., 2011, 365, 2484.

[8] van Dijk T.H., Tamas K., Beukema J.C., Beets G.L., Gelderblom A.J., de Jong K.P., et al.: “Evaluation of short-course radiotherapy followed by neoadjuvant bevacizumab, capecitabine, and oxaliplatin and subsequent radical surgical treatment in primary stage IV rectal cancer”. Ann. Oncol., 2013, 24, 1762.

[9] Clavarezza M., Turazza M., Aitini E., Saracchini S., Garrone O., Durando A., et al.: “Phase II open-label study of bevacizumab combined with neoadjuvant anthracycline and taxane therapy for locally advanced breast cancer”. Breast, 2013, 22, 470.

[10] Kim H.R., Jung K.H., Im S.A., Im Y.H., Kang S.Y., Park K.H., et al.: “Multicentre phase II trial of bevacizumab combined with docetaxel- carboplatin for the neoadjuvant treatment of triple-negative breast cancer (KCSG BR-0905)”. Ann. Oncol., 2013, 24, 1485.

[11] Ross R.W., Galsky M.D., Febbo P., Barry M., Richie J.P., Xie W., et al.: “Phase 2 study of neoadjuvant docetaxel plus bevacizumab in patients with high-risk localized prostate cancer: a Prostate Cancer Clinical Trials Consortium trial”. Cancer, 2012, 118, 4777.

[12] Hang X.F., Xu W.S., Wang J.X., Wang L., Xin H.G., Zhang R.Q., et al.: “Risk of high-grade bleeding in patients with cancer treated with bevacizumab: a meta-analysis of randomized controlled trials”. Eur. J. Clin. Pharmacol., 2011, 67, 613.

[13] Ellis A.M., Curley S.A., Grothey A.: “Surgical resection after downsizing of colorectal liver metastasis in the era of bevacizumab”. J. Clin. Oncol., 2005, 23, 4853.

[14] Hurwitz H., Fehrenbacher L., Novotny W., Cartwright T., Hainsworth J., Heim W., et al.: “Bevacizumab plus irinotecan,fluorouracil, and leucovarin for metastatic colorectal cancer”. N. Engl. J. Med., 2004, 350, 2335.

[15] Chéreau E., Lambaudie E., Houvenaeghel G.: “Morbidity of surgery after neoadjuvant chemotherapy including bevacizumab for advanced ovarian cancer”. Int. J. Gynecol. Cancer, 2013, 23, 1326.