Bevacizumab in recurrent epithelial ovarian cancer: real-world experience from a tertiary cancer hospital in India.

Background: In combination with chemotherapy, bevacizumab, a humanised monoclonal antibody against angiogenesis, significantly increases progression-free survival (PFS) in recurrent epithelial ovarian cancer (EOC). However, due to financial constraints, real-world experience with bevacizumab in EOC is lacking in Indian populations. This study assessed bevacizumab's efficacy with chemotherapy in platinum-sensitive and resistant EOC in resource-limited Indian populations.

Method and materials: This retrospective study was conducted at a regional cancer hospital in eastern India. Platinum-sensitive and resistant recurrent EOC patients were enrolled between 2021 and 2024. Patients' demographic and treatment details were retrieved from hospital medical records. All patients received bevacizumab 7.5 mg/kg IV dose with chemotherapy followed by maintenance till disease progression or inadvertent toxicity occurred. Primary endpoints were PFS and objective response rate (ORR); secondary endpoints were overall survival (OS) and safety. Kaplan-Meier plot generated PFS and OS survival curves.

Results: 48 patients were enrolled. With a median follow-up of 37 months, 46% of patients progressed on bevacizumab. The median duration of PFS was 17 months (95% CI, 14.31-19.68); it was slightly higher in platinum-sensitive patients at 18 months (95% CI, 14.25-21.74). Half of the patients achieved partial response, with an ORR of 66%. Median OS was not reached due to fewer events. The 3-year OS rate was 83%. About 15 patients who progressed on bevacizumab were able to receive further chemotherapy lines. No new safety concerns were noted. Only 4.2% of patients developed grade 3 proteinuria, one developed arterial thrombosis and two had grade 3 thrombocytopenia. Only one patient died due to a GI fistula.

Conclusion: Bevacizumab plus chemotherapy followed by bevacizumab maintenance till disease progression significantly improved PFS in recurrent EOC. This real-world finding suggests a crucial insight into effective treatment options for financially compromised Indian populations with recurrent EOC.