Introduction/Background Few data are available on Bevacizumab in neoadjuvant chemotherapy (NACT) setting for High Grade Serous ovarian Cancer (HGSC) patients. We investigate the effect of Bevacizumab addition to standard NACT regimen (Carboplatin and Paclitaxel) after Interval Debulking Surgery (IDS) failure following the first 3 NACT cycles.
Methodology This is a retrospective, single-centre study enrolling FIGO stage IIIC-IV HGSC patients (regardless of BRCA status) still considered unresectable after 3 cycles of NACT. Main inclusion criteria were: ECOG 0, age ranging from 40 to 75 years old, no contraindications to Bevacizumab administration. Patients were stratified whether they added Bevacizumab from cycle 4 to 6 (CPB group) or not (CP group). Primary endpoint was the cytoreduction rate after 6 cycles (delayed IDS).
Results From 2017 to 2021, 58 (23%) patients received neoadjuvant Bevacizumab (CPB), and 190 (77%) did not (CP). Only 118 (48%) women received delayed IDS: 31 in the CBP group (46%) and 87 (53%) in the CP one (p=0.38); complete gross resection was achieved in 26 (84%) and 77 (88%) patients, respectively (p=0.72). We did not find any difference in terms of severe early postoperative complications (8% for the CP group and 10% for the CPB one, p=0.069). Median Overall Survival (OS) was not significantly different between the two groups for those patients undergoing delayed IDS (not reached in the CPB and 38 months in the CP group, p=0.55). Conversely, among 130 (52%) patients still unresectable after 6 cycles, Bevacizumab had a significant effect on the CPB group’s median OS compared to the CP one (not reached vs 18 months, p=0.015).
Conclusion The use of Bevacizumab in neoadjuvant setting does not seem to increase the delayed IDS rate, nonetheless it prolongs OS for those patients persisting unsuitable for surgery. Thus, its administration may be an option in selected patients after failure of early IDS.
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