Real-World Study of Neoadjuvant Chemotherapy with Bevacizumab in Patients with Ovarian Cancer: A Chinese single-institution study

Abstract Background Bevacizumab was the first anti-angiogenic agent approved for the treatment of newly diagnosed and relapsed ovarian cancer. For patients with extensive tumor metastasis that is unsuitable for primary debulking surgery(PDS), platinum-based neoadjuvant chemotherapy(NACT) followed by interval debulking surgery(IDS) has become an important therapy strategy. The bevacizumab-containing regimens are also options for NACT and post-IDS chemotherapy. Although there have been many high-quality clinical trials of bevacizumab for ovarian cancer, real-world evidence is still necessary for clinical practice. Objective This study aimed to retrospectively assess the pattern, compliance, efficacy, and safety of bevacizumab as NACT in Chinese patients with ovarian cancer. Methods We reviewed the clinicopathological data of patients with histologically confirmed epithelial ovarian cancer, fallopian tube cancer and primary peritoneal adenocarcinoma, who were diagnosed and treated at the Department of Gynecologic Oncology of Peking University Cancer Hospital between May 2012 and January 2022. Results A total of 58 patients were ultimately enrolled in this study, with 35 receiving bevacizumab during NACT alone(NT) and 23 receiving bevacizumab during both neoadjuvant and first-line chemotherapy(NT + FL). Among the 43 patients in NT and NT + FL groups undergoing IDS, 38(88.4%) patients achieved optimal debulking and 24(55.8%) patients had no residual disease after IDS. All patients had a median PFS of 15 months (95%CI: 9.595–21.405), and the 12-month PFS was 60.2%. The median PFS of the NT and NT + FL groups were 13 months(95% CI: 9.738–16.262) and 20 months(95% CI:11.362–28.638), respectively. Nevertheless, there was no significant difference between the two groups(p = 0.113). According to multivariate analysis, patients treated with 15 mg/kg had a better PFS than those treated with ≤ 7.5 mg/kg(HR = 0.352, 95% CI: 0.143–0.864, P = 0.023). Hypertension was the most common adverse event associated with bevacizumab. A total of 5.2% (3/58) of patients discontinued bevacizumab due to toxicity. Conclusion Bevacizumab is effective and well-tolerated in the real-world setting of ovarian cancer NACT treatment. Receiving the regimen containing bevacizumab in the last preoperative chemotherapy did not result in increased intraoperative bleeding. Patients receiving the dosage of 15mg/kg may have better survival outcomes than those receiving the dosage of ≤ 7.5mg/kg.