Bevacizumab in Ovarian Cancer Treatment

Introduction to Bevacizumab Use

The National Comprehensive Cancer Network (NCCN) recommends against the routine use of bevacizumab in upfront treatment of ovarian cancer, categorizing it as a Category 3 recommendation, indicating >25% of NCCN panel members believe it is not appropriate 1, 2, 3

Most NCCN panel members believe bevacizumab should NOT be added to up-front chemotherapy in patients with ovarian cancer because GOG-0218 and ICON7 trials showed no statistically significant increase in overall survival and no improved quality of life 1, 2, 3
GOG-0218 demonstrated only a modest 3.8-month increase in progression-free survival when bevacizumab was given with carboplatin/paclitaxel followed by maintenance, with no overall survival benefit 1, 4, 5
ICON7 showed an even smaller 1.7-month progression-free survival benefit with no mature overall survival data at the time of guideline publication 1, 3, 6
Quality of life was similar between treatment arms in both trials, providing no additional justification for upfront use 1, 3

Single-agent bevacizumab is recommended as a PREFERRED recurrence therapy for platinum-resistant epithelial ovarian, fallopian tube, or primary peritoneal cancer 7, 8
Bevacizumab demonstrated a 21% response rate and is active in both platinum-sensitive and platinum-resistant patients 7
For platinum-sensitive recurrent disease, platinum-based combination regimens remain the preferred first-line approach, but bevacizumab can be added to platinum-based combinations in the recurrent setting 1, 7, 8

The risk-benefit calculation is unfavorable upfront, with serious adverse events including gastrointestinal perforation or fistula in <3% of patients 1, 2, 3
Common adverse reactions occurring at higher incidence (≥2%) with bevacizumab in recurrent ovarian cancer include hypertension, palmar-plantar erythrodysesthesia syndrome, proteinuria, and neutropenia 7

For newly diagnosed advanced ovarian cancer, do NOT routinely add bevacizumab to upfront carboplatin/paclitaxel, and consider only in clinical trial settings or after extensive discussion of limited benefits vs risks 1, 2, 3, 9
For recurrent platinum-resistant disease, use bevacizumab 10 mg/kg every 2 weeks (or 15 mg/kg every 3 weeks) with single-agent chemotherapy as preferred therapy 7, 8
For recurrent platinum-sensitive disease, prioritize platinum-based combination chemotherapy, and consider adding bevacizumab based on individual patient factors and ongoing trial data 1, 7, 8