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Arthralgia in patients with ovarian cancer treated with bevacizumab and chemotherapy
  1. Jole Ventriglia1,
  2. Immacolata Paciolla1,
  3. Carmela Pisano1,
  4. Rosa Tambaro1,
  5. Sabrina Chiara Cecere1,
  6. Marilena Di Napoli1,
  7. Laura Attademo1,
  8. Laura Arenare1,
  9. Anna Spina1,
  10. Daniela Russo1,
  11. Daniela Califano1,
  12. Nunzia Simona Losito1,
  13. Sergio Venanzio Setola1,
  14. Elisena Franzese1,2,
  15. Ferdinando De Vita2,
  16. Michele Orditura2 and
  17. Sandro Pignata1
  1. 1Istituto Nazionale Tumori di Napoli, Fondazione G.Pascale, IRCCS, Naples, Italy
  2. 2Division of Medical Oncology, Department of Precision Medicine, School of Medicine, "Luigi Vanvitelli" University of Campania, 80131 Naples, Italy
  1. Correspondence to Dr Jole Ventriglia, Department of Gynaecological Oncology, National Cancer Institute Napels, Naples, Italy, Napoli 80131, Italy; j.ventriglia{at}


Background Chemotherapy with carboplatin, paclitaxel, and bevacizumab is the standard therapy for patients with advanced stage ovarian cancer wild-type BRCA after primary surgery. The most frequent side effects of bevacizumab in this setting are hypertension, thrombosis, hemorrhage, and proteinuria, while arthralgia has been poorly described.

Objective To examine the incidence, duration, and reversibility of arthralgia.

Patients and methods A retrospective analysis was performed to describe the occurrence and outcome of arthralgia in 114 patients with advanced ovarian cancer, given first-line treatment with a combination of carboplatin, paclitaxel, and bevacizumab. Statistical analysis was performed to investigate a possible prognostic role of arthralgia, with progression-free survival as endpoint.

Results 47 of 114 patients (41%) developed arthralgia during therapy. All patients had grade 1 or grade 2 arthralgia. Toxicity persisted after the end of bevacizumab in 17/47 patients (36%). Median progression-free survival for patients without arthralgia was 18 months (95% CI 14 to 24) compared with 29 months (95% CI 21 to not reached) for patients experiencing arthralgia (p=0.03). In order to avoid possible biases related to treatment duration, a multivariable Cox proportional hazards model including toxicity as a time dependent variable and age, stage, and residual disease after primary surgery was performed. In this model no variable showed a statistically significant association with progression-free survival.

Conclusion A high incidence of arthralgia (41%) was found and although rogression-free survival was worse for those patients who developed arthralgia, this was not maintained on multivariate analysis. Guidelines for treatment of this adverse event are needed.

  • ovarian cancer
  • quality of life (PRO)/palliative care

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  • Contributors JV created the database and drafted the manuscript; IP created the database, EF collected data, LAr performed the statistical analysis. CP, SCC, MDN, LAt, RT, MO, FDV revised the article critically. SP revised the article critically for important intellectual content and approved the final version to be published. DC, NSL, DR, AS, SVS participated in the acquisition and collection of data.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request. we have database with deidentified participant data available after request to corresponding author.