Timing and duration of bevacizumab treatment and survival in patients with recurrent ovarian, fallopian tube, and peritoneal cancer: a multi-institution study
1Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Washington, Seattle, WA 98195, USA
2Gynecologic Oncology Program, Department of Obstetics and Gynecology, University of New Mexico, Albuquerque, NM 87131, USA
3Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Robert H Lurie Comprehensive Cancer Center, Chicago, IL 60611, USA
4Jordan Center for Gynecologic Cancer at Penn, Perelman Center for Advanced Medicine, University of Pennsylvania Health System, Philadelphia, PA 19104, USA
5Department of Gynecologic Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA
6Swedish Cancer Institute Gynecologic Oncology and Pelvic Surgery, Seattle, WA 98104, USA
7Gynecological Cancer Institute of Chicago, Oak Lawn, IL 60453, USA
8Public Health Sciences Division, Fred Hutchinson Cancer Center, Seattle, WA 98109, USA
DOI: 10.22514/ejgo.2023.002 Vol.44,Issue 1,February 2023 pp.17-25
Submitted: 27 July 2022 Accepted: 31 October 2022
Published: 15 February 2023
*Corresponding Author(s): Talayeh S. Ghezelayagh E-mail: firstname.lastname@example.org
*Corresponding Author(s): John B. Liao E-mail: email@example.com
† These authors contributed equally.
Bevacizumab has demonstrated significant benefit in recurrent ovarian, fallopian tube and peritoneal cancer (OC), but its optimal position within the sequence of systemic therapies remains controversial. Since rebound progression after bevacizumab has been observed in other cancers, and because bevacizumab is incorporated in several regimens used in the recurrent setting, the duration of treatment may impact survival. We sought to identify whether earlier bevacizumab exposure is associated with prolonged bevacizumab therapy and survival by conducting a multi-institution retrospective study of recurrent OC patients treated with bevacizumab from 2004–2014. Multivariate logistic regression identified factors associated with receiving more than six bevacizumab cycles. Overall survival by duration and ordinal sequence of bevacizumab therapy were evaluated using logrank testing and Cox regression. In total, 318 patients were identified. 89.1% had stage III or IV disease; 36% had primary platinum resistance; 40.5% received two or fewer prior chemotherapy regimens. Multivariate logistic regression demonstrated that primary platinum sensitivity (Odds Ratio (OR) 2.34, p = 0.001) or initiating bevacizumab at the first or second recurrence (OR 2.73, p < 0.001) were independently associated with receiving more than six cycles of bevacizumab. Receiving more cycles of bevacizumab was associated with improved overall survival whether measured from time of diagnosis (logrank p < 0.001), bevacizumab initiation (logrank p < 0.001), or bevacizumab discontinuation (logrank p = 0.017). Waiting one additional recurrence to initiate bevacizumab resulted in a 27% increased hazard of death (Hazard Ratio (HR) 1.27, p < 0.001) by multivariate analysis. In conclusion, patients with primary platinum sensitive disease who received fewer prior lines of chemotherapy were able to receive more cycles of bevacizumab, which was associated with improved overall survival. Survival worsened when bevacizumab was initiated later in the ordinal sequence of therapies.
Ovarian cancer; Bevacizumab; Overall survival; Platinum sensitivity; Fallopian tube cancer
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