Continuous bevacizumab plus second line chemotherapy beyond progression during or after maintenance bevacizumab

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http://dx.doi.org/10.18081/jcc/016-06/12-23
Journal of Cellular Cancer  Volume 8, Issue 1, pages 12-23
Received January 28, 2016; accepted May 21, 2016; published June 17, 2016

Haider Y. Shukur1*

Abstract

Bevacizumab has FDA approval in the first and second line treatment combined with chemotherapy of epithelial ovarian cancer (EOC). Data is lacking on survival outcomes in patients who are continuous treated with bevacizumab plus second line chemotherapy when progressing during or after maintenance bevacizumab who had achieved CR/PR. The objectives of study are to evaluate efficacy (PFS & OS) and toxicity of  continuous bevacizumab plus second line chemotherapy beyond progressed during or after maintenance bevacizumab depending on results of three trials of continuous bevacizumab beyond progression in MCRC (TML, GONO & BRiTE) where all of these trials showed significant improvement in survival when continuous with bevacizumab beyond progression. This was a prospective study conducted at a single institution. Patients that received bevacizumab in either the front-line setting then in maintenance which progress during or after maintenance were included. Response was graded according to RECIST criteria or CA125. PFS was defined as the time of start continuous bevacizumab treatment when progression or recurrent until progression or date of last contact. OS was defined as the time of start continuous bevacizumab treatment when progression or recurrent until death or date of last contact. There were a total of 20 patients who had a CR/PR to a bevacizumab containing regimen. Of those, 12 had progressed during bevacizumab maintenance therapy and 8 had recurrence after finished bevacizumab containing regimen. Patients had mean PFS 12 months and OS was 18  months. The objective response rate (ORR) defined as (CR& PR) was 45% and (CBR) defined as CR, PR, SD, was 80%. Continuous treatment with bevacizumab beyond  progression during maintenance bevacizumab or recurrent after achieving response to first line chemotherapy plus bevacizumab then bevacizumab maintenance is associated with improved PFS and CBR. This is the first of such report in this patients population. The 12- month achieved in PFS and the 18-months achieved in OS strongly supports the continuous bevacizumab  in patients who demonstrate an initial response to maintenance bevacizumab or recurrent their after in heavily pretreated with bevacizumab. This strategy should be formally tested in future clinical trials and further investigation should include evaluation of predictors of response to bevacizumab therapy.

Keywords: Bevacizumab; CA125; FDA; ORR

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