Single-agent bevacizumab for the management of refractory malignant effusions in heavily pretreated patients with recurrent high-grade serous cancers of the ovary, fallopian tube or peritoneum: results from a single institution

Purpose of Investigation: The authors conducted a retrospective review of single-agent bevacizumab in the management of chemotherapy- refractory malignant effusions in high-grade serous carcinomas (HGSCs). Material and Methods: Eligible patients who received single-agent bevacizumab as treatment of refractory malignant effusions were included. The mean paracentesis/thoracentesis interval (MPTI) in days was determined pre- and post-bevacizumab for each patient. Treatment response was defined by a doubling of the MPTI. Results: Ten cases were evaluable. Median age was 64 years (47- to 70-years-old). Median number of prior lines of chemotherapy was 6 (range 3-9). The MPTI pre- and post-bevacizumab was 19.6 (3.5-60.5) and 34.8 (5-83) days, respectively. Response rate was 50% (5/10 cases). There was a trend to significance in the difference between the pre- and post-bevacizumab MPTI (p = 0.26). Three patients had an extremely long MPTI greater than 60 days between subsequent paracenteses. Conclusions: Single agent bevacizumab is useful in the management of symptomatic chemotherapy-refractory malignant effusions in HGSC.

Ascites; Ovarian cancer; Fallopian tube cancer; Peritoneal cancer; Bevacizumab.

[1] 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.

[2] Kraft A., Weindel K., Ochs A., Marth C., Zmija J., Schumacher P., et al.: “Vascular endothelial growth factor in the sera and effusions of patients with malignant and nonmalignant disease”. Cancer, 1999, 85, 178.

[3] Zebrowski B.K., Liu W., Ramirez K., Akagi Y., Mills G.B., Ellis L.M.: “Markedly elevated levels of vascular endothelial growth factor in malignant ascites”. Ann. Surg. Oncol., 1999, 6, 373.

[4] Gotlieb W.H., Amant F., Advani S., Goswami C., Hirte H., Provencher D., et al.: “Intravenous aflibercept for treatment of recurrent symptomatic malignant ascites in patients with advanced ovarian cancer: a phase 2, randomised, double-blind, placebo-controlled study”. Lancet Oncol., 2012, 13, 154.

[5] El-Shami K., El-Kerm Y.: “Open- label safety and efficacy pilot trial of intraperitoneal bevacizumab as palliative treatment in refractory malignant ascites”. J. Clin. Oncol., 2007, 25, 9043.a

[6] Hamilton C.A., Maxwell G.L., Chernofsky M.R., Bernstein S.A., Farley J.H., Rose G.S.: “Intraperitoneal bevacizumab for the palliation of malignant ascites in refractory ovarian cancer”. Gynecol. Oncol., 2008, 111, 530,

[7] Numnum T.M., Rocconi R.P., Whitworth J., Barnes M.N.: “The use of bevacizumab to palliate symptomatic ascites in patients with refractory ovarian carcinoma”. Gynecol. Oncol., 2006, 102, 425.

[8] Despierre E., Yesilyurt B.T., Lambrechts S., Johnson N., Verheijen R., van der Burg M., et al.: “Epithelial ovarian cancer: rationale for changing the one-fits-all standard treatment regimen to subtype-specific treatment”. Int. J. Gynecol. Cancer, 2014, 24, 468.

[9] Ferriss J.S., Java J.J., Bookman M.A., Fleming G.F., Monk B.J., Walker J.L., et al.: “Ascites predicts treatment benefit of bevacizumab in front-line therapy of advanced epithelial ovarian, fallopian tube and peritoneal cancers: an NRG Oncology/GOG study”. Gynecol. Oncol., 2015, 139, 17.