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Survival in stage IV ovarian cancer with increased use of debulking surgery and bevacizumab
  1. Leen Verleye1,
  2. Diego Castanares-Zapatero1,
  3. Carl Devos1,
  4. Cindy De Gendt2,
  5. Geert Silversmit2,
  6. Nancy Van Damme2,
  7. Frank Hulstaert1,
  8. Nancy Thiry1 and
  9. Mattias Neyt1
  1. 1Belgian Health Care Knowledge Centre, Brussel, Belgium
  2. 2Belgian Cancer Registry, Brussels, Belgium
  1. Correspondence to Dr Leen Verleye, Belgian Health Care Knowledge Centre, Brussel, 1000, Belgium; leen.verleye{at}kce.fgov.be

Abstract

Objectives Advanced ovarian cancer has a poor prognosis, with a 5 year survival probability of <30%. Attempts to improve survival have focused on debulking surgery and systemic therapy. We assessed the evolution of treatment patterns and survival of patients with advanced epithelial ovarian cancer with specific attention to changes in survival after introducing bevacizumab.

Methods Population based data from the Belgian Cancer Registry were coupled with administrative reimbursement data from the compulsory health insurance organizations and the national database where date of death is registered, based on the patient's unique national number. Patients with epithelial ovarian cancer stage IV diagnosed in 2004–17 were included. The proportion of patients who underwent debulking surgery and received bevacizumab was calculated per incidence year. Survival was compared for the three incidence periods (2004–08, 2009–13, 2014–17) and before and after the introduction of bevacizumab.

Results 2034 patients with stage IV epitheial ovarian cancer were included. From 2012 onwards, uptake of bevacizumab increased, with 50% of patients with stage IV ovarian cancer diagnosed in 2017 receiving bevacizumab. The proportion of stage IV patients who underwent debulking surgery also increased over time, from 21.1% in 2004–08 to 50.4% and 45.4% in 2009–13 and 2014–17, respectively. The 3 year observed survival probability fluctuated between 27% and 42% without a trend over time. The increase in debulking surgery was associated with improved survival (hazard ratio (HR) 0.88, 95% confidence interval (CI) 0.79 to 0.98) but the introduction of bevacizumab was not (HR 0.94, 95% CI 0.85 to 1.03). For patients diagnosed in 2004, the mean cost per patient treated with oncological drugs was about €12 500, which doubled to about €25 000 for patients diagnosed in 2014 or later.

Conclusions Despite a rise in the use of debulking surgery and the introduction of bevacizumab into clinical practice, no improvement in 3 year survival probability was observed for patients with advanced ovarian cancer in Belgium.

  • Ovarian Cancer
  • Surgery
  • Medical Oncology

Data availability statement

Data are available upon reasonable request. The cancer cohort data used and analyzed in the study are available from the authors upon reasonable request. The pseudonymized data can be provided within the secured environment of the Belgian Cancer Registry after having been guaranteed that the applicable GDPR regulations are applied.

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Data availability statement

Data are available upon reasonable request. The cancer cohort data used and analyzed in the study are available from the authors upon reasonable request. The pseudonymized data can be provided within the secured environment of the Belgian Cancer Registry after having been guaranteed that the applicable GDPR regulations are applied.

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Footnotes

  • Contributors LV, DC-Z, CD, CDG, GS, NVD, FH, NT, and MN contributed to the conception and design of the study. CDG, GS, and CD analyzed the data. Data interpretation was performed by LV, DC-Z, CD, CDG, GS, NVD, FH, NT, and MN. LV wrote the first draft of the manuscript. Guarantor: LV

  • 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.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.