Recurrence patterns after extended treatment with bevacizumab for ovarian, fallopian tube, and primary peritoneal cancers

Abstract

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Highlights

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Ovarian cancer patients treated with bevacizumab predominantly recurred in lymph nodes.

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Patients on extended bevacizumab treatment presented with fewer symptoms at time of recurrence than those receiving fewer cycles of bevacizumab.

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Radiologic imaging is superior to serum CA-125, symptoms, and physical exam for the detection of recurrent disease in patients treated with bevacizumab.

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Objective

To evaluate patterns of recurrence for ovarian, fallopian tube, and primary peritoneal cancer patients undergoing extended treatment with bevacizumab (BEV).

Methods

A retrospective review of patients with primary ovarian, fallopian tube, or peritoneal cancer treated with BEV alone or in combination with other chemotherapy from 2001 to 2011 was performed. Qualified patients were identified by chemotherapy records. Electronic medical records, labs, and imaging reports were reviewed and abstracted.

Results

Of 108 patients identified, 89 patients met study criteria by having disease progression either during treatment with BEV or after discontinuing BEV without initiating any other treatment. Patients on extended BEV therapy (> 12 cycles) were more likely to recur in extra-visceral sites (p = 0.04), especially in lymph nodes (p = 0.0002), and presented with fewer symptoms at time of recurrence (p = 0.02), compared to patients who had received ≤ 12 cycles. CA-125 becomes less reliable for the detection of recurrent disease with extended BEV therapy (p = 0.03 for ≤ 12 cycles vs. p = 0.08 for > 12 cycles). Radiology was superior to CA-125, symptom, and physical exam, in detecting recurrence with extended BEV therapy (all p < 0.0001).

Conclusions

Extended treatment with BEV in ovarian, fallopian tube, and peritoneal cancers results in alterations in the patterns of recurrence. Radiologic imaging is more reliable than CA-125, symptoms, or physical exam, in identifying recurrent disease in patients undergoing BEV treatment. As novel targeted therapies continue to be employed, guidelines for gynecologic cancer surveillance must continue to be reexamined.

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Presented in part at the Society of Gynecologic Oncology Annual Meeting on Women’s Cancer, Los Angeles, California, USA. March 9 – 12, 2013.