A new study published online May 12 in Cancer demonstrates that adding bevacizumab to first-line chemotherapy provides meaningful clinical benefits for patients with high-risk epithelial ovarian cancer, confirming in real-world settings what previous clinical trials had suggested.
Researchers led by Dr. Linda R. Duska from the University of Virginia School of Medicine analyzed electronic health records of 1,752 patients with stage III/IV epithelial ovarian cancer who received first-line chemotherapy with or without bevacizumab. With a median follow-up of 18.5 months, the study specifically examined real-world time to next treatment and overall survival outcomes.
Benefits Limited to High-Risk Patient Subgroups
The analysis revealed that bevacizumab's benefits were concentrated in specific high-risk populations. Patients with stage IV disease or stage III disease with either visible residual disease or no documentation of surgery showed significantly longer real-world time to next treatment when receiving chemotherapy plus bevacizumab compared to chemotherapy alone (13.6 versus 11.7 months).
These high-risk patients also demonstrated a trend toward improved overall survival, with median real-world overall survival reaching 31.1 months with bevacizumab addition compared to 27.4 months with chemotherapy alone.
Importantly, patients without these high-risk prognostic factors did not show significant differences in outcomes whether bevacizumab was added or not, suggesting a targeted approach to using this therapy may be most appropriate.
Clinical Implications for Treatment Selection
"Results suggested that the real-world benefit of adding bevacizumab to a first-line chemotherapy regimen was limited to patients with high-risk prognostic factors," the study authors wrote. This finding has important implications for clinical decision-making and resource allocation in ovarian cancer treatment.
The study builds on previous clinical trial data that had shown bevacizumab improved progression-free survival in advanced epithelial ovarian cancer. This real-world evidence now provides additional support for its use in specific patient populations.
Study Limitations and Funding
The research team acknowledged several limitations to their analysis. The study was funded by GSK, and several authors disclosed financial relationships with biopharmaceutical companies, including GSK.
Bevacizumab, an angiogenesis inhibitor that works by blocking the formation of new blood vessels that feed tumors, has been used in various cancer treatments. This study helps refine understanding of which ovarian cancer patients are most likely to benefit from its addition to standard chemotherapy regimens.
For clinicians treating epithelial ovarian cancer, these findings suggest that patient selection based on risk factors may optimize treatment outcomes while potentially avoiding unnecessary therapy for those unlikely to benefit.
