J Gynecol Oncol.  2013 Jul;24(3):258-264. 10.3802/jgo.2013.24.3.258.

The combination of intravenous bevacizumab and metronomic oral cyclophosphamide is an effective regimen for platinum-resistant recurrent ovarian cancer

• Barber EL
• Zsiros E
• Lurain JR
• Rademaker
• Schink JC
• Neubauer N

• KMID: 2288533
• DOI: http://doi.org/10.3802/jgo.2013.24.3.258

Abstract

OBJECTIVE
To determine the efficacy, progression-free survival (PFS) and overall survival (OS) for the combination of intravenous bevacizumab and oral cyclophosphamide in heavily pretreated patients with recurrent ovarian carcinoma.
METHODS
A retrospective review was performed for all patients with recurrent ovarian carcinoma treated with intravenous bevacizumab 10 mg/kg every 14 days and oral cyclophosphamide 50 mg daily between January 2006 and December 2010. Response to treatment was determined by Response Evaluation Criteria in Solid Tumors criteria and/or CA-125 levels.
RESULTS
Sixty-six eligible patients were identified. Median age was 53 years. Fifty-five patients (83%) had undergone optimal cytoreduction. All patients were primarily or secondarily platinum resistant at the time of administration of bevacizumab and cyclophosphamide. The median number of prior chemotherapy treatments was 6.5 (range, 3 to 16). Eight patients (12.1%) had side effects which required discontinuation of bevacizumab and cyclophosphamide. There was one bowel perforation (1.5%). Overall response rate was 42.4%, including, complete response in 7 patients (10.6%), and partial response in 21 patients (31.8%), while 15 patients (22.7%) had stable disease and 23 patients (34.8%) had disease progression. Median PFS for responders was 5 months (range, 2 to 14 months). Median OS from initiation of bevacizumab and cyclophosphamide was 20 months (range, 2 to 56 months) for responders and 9 months (range, 2 to 51 months) for non-responders (p=0.004).
CONCLUSION
Bevacizumab and cyclophosphamide is an effective, well-tolerated chemotherapy regimen in heavily pretreated patients with recurrent ovarian carcinoma. This combination significantly improved PFS and OS in responders. Response rates were similar and favorable to the rates reported for similar patients receiving other commonly used second-line chemotherapeutic agents.

Keyword

Anti-angiogenic therapy; Bevacizumab; Cyclophosphamide; Platinum resistant ovarian carcinoma; Recurrent ovarian carcinoma

MeSH Terms

Antibodies, Monoclonal, Humanized
Bevacizumab
Cyclophosphamide
Disease Progression
Disease-Free Survival
Humans
Ovarian Neoplasms
Platinum
Retrospective Studies
Antibodies, Monoclonal, Humanized
Cyclophosphamide
Platinum

Figure

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  Fig. 1 Progression-free (A) and overall survival (B) from the initiation of bevacizumab and cylophosphamide between responders and non-responders.

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