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Recurrence patterns after bevacizumab in platinum-sensitive, recurrent epithelial ovarian cancer
  1. Se Ik Kim,
  2. Eun Ji Lee,
  3. Maria Lee,
  4. Hyunhoon Chung,
  5. Jae-Weon Kim,
  6. Noh Hyun Park,
  7. Yong-Sang Song and
  8. Hee Seung Kim
  1. Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
  1. Correspondence to Dr Hee Seung Kim, Obstetrics and Gynecology, Seoul National University, Seoul 03080, Korea (the Republic of); bboddi0311{at}


Objective Evidence on recurrence patterns after bevacizumab in epithelial ovarian cancer is still insufficient. The aim of this study was to evaluate recurrence patterns after treatment with bevacizumab as second-line treatment in patients with platinum-sensitive, recurrent epithelial ovarian cancer.

Methods We retrospectively identified epithelial ovarian cancer patients who relapsed ≥6 months after primary treatment consisting of surgery and platinum-based chemotherapy between January 2008 and June 2019. Only those who received platinum-based doublet chemotherapy with bevacizumab or without bevacizumab as second-line treatment were included (n=192). To adjust confounders, we conducted 1:2 propensity score matching for platinum-free interval and secondary debulking surgery. Imaging studies were performed to locate newly developed or enlarged pre-existing tumors. Recurrence patterns were compared between bevacizumab users (study group) and non-users (control group).

Results After matching, the study group (n=52) and control group (n=104) showed similar baseline clinicopathologic characteristics including platinum-free interval (median (range) 15.3 (6.2–87.3) vs 14.0 (6.2–143.5) months; p=0.29) and patient age at the time of first recurrence (median (range) 55.5 (33.7–72.4) vs 55.0 (35.7–84.2) years; p=0.56). Initially, FIGO stage III disease was the most common in both two groups (55.8% vs 66.3%; p=0.20). Bevacizumab users were less likely to develop disease recurrence in the retroperitoneal lymph nodes (13.5% vs 34.6%; p=0.005), pelvis (17.3% vs 35.6%; p=0.018), and abdomen (40.4% vs 61.5%; p=0.012). However, no difference in distant metastasis was observed between the groups (23.1% vs 24.0%; p>0.99). Multivariate analyses adjusting for stage, histologic type, grade, platinum-free interval, and secondary debulking surgery revealed that the use of bevacizumab significantly reduced risks of nodal (adjusted HR (aHR) 0.24; 95% CI 0.10 to 0.56; p=0.001), pelvic (aHR 0.32; 95% CI 0.15 to 0.68; p=0.003), and abdominal recurrences (aHR 0.43; 95% CI 0.26 to 0.71; p=0.001). Nevertheless, use of bevacizumab did not influence risk of distant metastasis (aHR 0.70; 95% CI 0.35 to 1.40; p=0.32).

Conclusions In patients with platinum-sensitive, recurrent epithelial ovarian cancer, second-line chemotherapy with bevacizumab is associated with reduced risks of nodal, pelvic, and abdominal recurrences, but similar risks of distant metastases.

  • genital neoplasms
  • female
  • ovarian neoplasms
  • ovary
  • ovarian cancer

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  • Contributors Conceptualization: SIK, HSK. Methodology: SIK, HSK. Data acquisition: SIK, EJL. Validation: SIK, ML, HSK. Formal analysis and investigation: SIK, HSK. Writing - original draft: SIK. Writing - review & editing: all authors. Supervision: HSK.

  • Funding This research was supported by grants from Seoul National University (No. 800-20170249; 800-20180201) and Seoul National University Hospital (No. 0620173250).

  • 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.