The Efficacy and Toxicity of Bevacizumab in Combination With Gemcitabine in Patients With Recurrent Ovarian Cancer

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Background:To evaluate the efficacy and toxicity of bevacizumab in combination with gemcitabine in patients with recurrent ovarian cancer.Patients and Methods:A retrospective analysis identified patients with recurrent ovarian cancer who received combination bevacizumab and gemcitabine. The patients received bevacizumab (15 mg/m2) every 3 weeks, plus gemcitabine (750-1000 mg/m2) on days 1 and 8 until disease progression or undue toxicity. Toxicity was assessed by using National Cancer Institute CTCAE (Common Terminology Criteria for Adverse Events) version. 3.0. Response rates were determined by serial cancer antigen 125 levels and by radiologic evaluation.Results:Twenty-nine patients were treated with combination therapy. The median age was 51 years (range, 38-70 years); 59% had primary platinum-resistant disease. The median number of previous chemotherapy regimens was 2 (range, 1-5). Five patients experienced grade 3/4 nausea and vomiting. Four patients had grade 3/4 neutropenia. One patient had grade 3/4 proteinuria, and no patients had grade 3/4 hypertension. Eight patients had the bevacizumab infusion delayed due to proteinuria. Six patients had the gemcitabine infusion delayed or reduced due to grade 3/4 toxicity. One patient developed a colovesical fistula. Three patients developed a colon obstruction. Two patients (7%) had a complete response, and 9 patients (31%) had a partial response for an overall response rate of 38%. The median duration of response was 9.6 months (range, 1-49 months). Four patients (14%) had stable disease, and 14 patients (48%) had progressive disease.Conclusion:Combination treatment with bevacizumab and gemcitabine has activity in recurrent ovarian cancer and is well tolerated. Prospective trials are needed to further characterize the role of this regimen in the treatment of recurrent ovarian cancer.

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