Erciyestepe Mert, Dinç Sonuşen Şermin, Seçmeler Şaban, Aydın Okan, Öztürk Ahmet Emin, Büyükkuşcu Aslı, Erciyestepe Sezgi Güllü, Çelik Emir, Erturk Kayhan, Atcı Muhammed Mustafa
Department of Medical Oncology, Sağlık Bilimleri University, Prof. Dr. Cemil Taşcıoğlu City Hospital, İstanbul, Turkey.
Department of Gynecology and Obstetric, Acıbadem Health Group, Acıbadem Bakırköy Hospital, İstanbul, Turkey.
Cancer Manag Res. 2025 Aug 18;17:1679-1688. doi: 10.2147/CMAR.S531276. eCollection 2025.
High recurrence rates and the emergence of resistance mechanisms in ovarian cancer necessitate exploring alternative therapeutic strategies except platinum-based chemotherapies. This has led to the development of bevacizumab, a recombinant humanized monoclonal antibody targeting VEGF. Nevertheless, the continuation of bevacizumab treatment initiated alongside chemotherapy, especially after disease progression, remains a topic of debate.
Our study involved a single-center retrospective analysis of the medical records of patients diagnosed with stage 3 and 4 epithelial ovarian cancer between June 2011 and January 2023. All patients in our study were platinum-sensitive.
Patients with residual disease >1 cm following initial surgery had significantly worse median OS (p = 0.002). Post-progression, patients were divided into two groups based on whether bevacizumab was continued. More than half of the patients who continued treatment with bevacizumab and chemotherapy achieved a 5-year OS, which was statistically superior (p < 0.001). When comparing PFS between patients who did and did not receive bevacizumab in the second line following recurrence/progression, those treated with bevacizumab demonstrated a median PFS of 12.0 months (95% CI: 10.5-13.4), which was significantly better (p < 0.001). The hazard ratio for mortality in patients continuing bevacizumab treatment beyond progression was 0.11 (95% CI: 0.05-0.22) (p < 0.001).
Many studies have shown the effectiveness and survival benefit of bevacizumab in epithelial ovarian cancer. In contrast, the literature offers limited studies addressing the survival benefits of continuing bevacizumab beyond disease progression. However, our study indicates that continuing bevacizumab beyond progression significantly contributes to both OS (p < 0.001) and PFS (p < 0.001). As larger studies with similar results to ours are conducted in the future, current guidelines may improve, and the decision to continue bevacizumab treatment after progression may become more evidence-based.
卵巢癌的高复发率以及耐药机制的出现使得有必要探索除铂类化疗之外的替代治疗策略。这促使了贝伐单抗的研发，它是一种靶向血管内皮生长因子（VEGF）的重组人源化单克隆抗体。然而，在化疗同时启动的贝伐单抗治疗的延续，尤其是在疾病进展后，仍然是一个有争议的话题。
我们的研究涉及对2011年6月至2023年1月期间诊断为3期和4期上皮性卵巢癌患者的病历进行单中心回顾性分析。我们研究中的所有患者对铂类敏感。
初次手术后残留病灶>1 cm的患者中位总生存期显著更差（p = 0.002）。疾病进展后，根据是否继续使用贝伐单抗将患者分为两组。超过一半继续接受贝伐单抗和化疗的患者实现了5年总生存期，这在统计学上更具优势（p < 0.001）。在复发/进展后的二线治疗中，比较接受和未接受贝伐单抗治疗的患者的无进展生存期时，接受贝伐单抗治疗的患者中位无进展生存期为12.0个月（95%置信区间：10.5 - 13.4），显著更好（p < 0.001）。疾病进展后继续使用贝伐单抗治疗的患者的死亡风险比为0.11（95%置信区间：0.05 - 0.22）（p < 0.001）。
许多研究表明贝伐单抗在上皮性卵巢癌中的有效性和生存获益。相比之下，关于疾病进展后继续使用贝伐单抗的生存获益的文献研究有限。然而，我们的研究表明疾病进展后继续使用贝伐单抗对总生存期（p < 0.001）和无进展生存期（p < 0.001）均有显著贡献。随着未来开展更多与我们结果相似的研究，当前指南可能会得到改进，疾病进展后继续使用贝伐单抗治疗的决策可能会更具循证性。
