Introduction/Background Bevacizumab (Bev) plus neoadjuvant chemotherapy (NACT) with carboplatin and paclitaxel (CP) has shown to improve complete resection rates (CRR) in advanced epithelial ovarian cancer (AEOC) in a phase II trial, but its effect on specific metastatic sites is still unknown. We examined region-specific response rates during interval debulking surgery (IDS) to identify subpopulations that benefit most from Bev in NACT.

Methodology We retrospectively reviewed 68 patients with AEOC who received NACT with CP plus Bev (15 mg/kg) and subsequent interval debulking surgery (IDS) at Tata Medical Centre, Kolkata, India, from 2019 to 2021. Metastatic sites were assessed using contrast-enhanced CT scans pre- and post-NACT. Both surgical and histopathological analyses confirmed intra-abdominal sites of metastases. Region-specific response rates, complete resection rates (CRR), chemotherapy response scores (CRS), and progression-free survival (PFS) were analysed.

Results Among the 68 patients, 41 (60.2%) were classified as stage IV due to extra-abdominal metastasis. The pre-NACT distribution of disease within the abdominal cavity was as follows: omentum (95.5%), right diaphragm (73.5%), left diaphragm (64.7%), large bowel serosa (63.2%), retroperitoneal lymph nodes (RPLN) (45.5%), small bowel (41.1%), liver metastasis (17.6%), and portal disease (11.7%). A bowel surgery was required only in 22% of patients, showing the most common area of response to NACT, while the RPLN area exhibited the lowest response rate. The CRR was 83.6%, significantly higher than the phase II ANTHALYA trial. A CRS of two or more was achieved in 88.2% of patients. The median PFS was 18.6 months, which was significantly higher than the median PFS reported in the EORTC 55971 trial.

Conclusion The addition of bevacizumab to neoadjuvant CP has shown the highest efficacy in improving bowel serosal disease. It has resulted in improved CRR at IDS and PFS in AEOC patients. Our study urges further research on bevacizumab in NACT for AEOC.

Disclosures No conflict of interest