Long survival metastatic ovarian neoplasm under bevacizumab maintenance strategy

The prognosis of metastatic invasive epithelial ovarian tumor is poor, with a five-year survival rate under 20%. The author reports the case of a 71-year-old woman, diagnosed at the age of 65 years, with a serous papillary ovarian carcinoma with diffuse peritoneal carcinomatosis. She received four courses of neoadjuvant carboplatin plus paclitaxel chemotherapy, then underwent debulking surgery, followed by three courses of chemotherapy. Seventeen months later, diffuse metastases appeared. The patient received six cycles of carboplatin plus paclitaxel chemotherapy and obtained complete response. Ten months later, carboplatin plus gemcitabine plus bevacizumab were administered for a new relapse, followed by bevacizumab maintenance. After 28 months of bevacizumab treatment, the anti-VEGF therapy was stopped, because of proteinuria and renal failure. The patient is under hormonal therapy and has stable disease.

Ovarian carcinoma; Metastasis; Bevacizumab; Maintenance; Anti-VEGF; Proteinuria; Toxicity.

[1] 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.

[2] 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.

[3] Pujade-Lauraine E., Hilpert F., Weber B., Reuss A., Poveda A., Kristensen G., et al.: “Bevacizumab combined with chemotherapy for platinum-resistant recurrent ovarian cancer: the AURELIA openlabel randomized phase III trial”. J. Clin. Oncol., 2014, 32, 1302.

[4] Aghajanian C., Blank S.V., Goff B.A., Judson P.L., Teneriello M.G., Husain A., et al.: “OCEANS: a randomized, double-blind, placebocontrolled 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.

[5] Oza A.M., Cook A.D., Pfisterer J., Embleton A., Ledermann J.A., Pujade-Lauraine E., et al.: “Standard chemotherapy with or without bevacizumab for women with newly diagnosed ovarian cancer (ICON7): overall survival results of a phase 3 randomised trial”. Lancet Oncol., 2015, 16, 928.

[6] Qi W.X., Shen Z., Tang L.N., Yao Y.: “Bevacizumab increases the risk of gastrointestinal perforation in cancer patients: A meta-analysis with a focus on different subgroups”. Eur. J. Clin. Pharmacol., 2014, 70, 893.

[7] Zhu X., Wu S., Dahut W.L. and Parikh C.R.: “Risks of proteinuria and hypertension with bevacizumab, an antibody against vascular endothelial growth factor: Systematic review and meta-analysis”. Am. J. Kidney Dis., 2007, 49, 186.

[8] Markman M., Iseminger K.A., Hatch K.D., Creasman W.T., Barnes W., Dubeshter B.: “Tamoxifen in platinum refractory ovarian cancer. A Gynecologic Oncology Group ancillary report”. Gynecol. Oncol., 1996, 62, 4.