Adding the angiogenesis inhibitor bevacizumab to initial
standard chemotherapy followed by bevacizumab alone as
maintenance therapy prolongs progression-free survival
(PFS) time significantly but modestly in women with
advanced epithelial ovarian cancer. This finding has been
reported consistently by two phase III trials, GOG-218
and ICON 7. At present, overall survival (OS) data are
immature. Therefore, no recommendation can be made
yet how to best incorporate bevacizumab in the front-line
treatment of advanced ovarian cancer.
Members of the gynecological cancer working group of
the Swiss Group for Clinical Cancer Research (SAKK) and
other specialists have discussed the latest findings with
bevacizumab in ovarian cancer and their consequences for
Ovarian cancer is the seventh most frequent cancer in
women worldwide (1). Its incidence rates are highest in
the western world, where it is the leading cause of death
from gynecological malignancies (2, 3).
Patients with stage III and IV ovarian cancer require a
combined approach of surgery and chemotherapy. Primary
debulking surgery plays a key role and the final outcome
is highly dependent on the results achieved with the initial
surgery: a residual tumor of >1 cm was found to be associated
with a median overall survival of 12–16 months,
while a longer median overall survival has been reported
in patients with no macroscopic residual disease (4). The
ultimate goal of surgery is cytoreduction to microscopic
disease, the term optimal cytoreduction being reserved for
those cases with no macroscopic residual disease.
The standard first-line chemotherapy for advanced ovarian
cancer usually contains a taxane and a platinum agent
for six cycles (5-8). The response rate for this treatment is approximately 75%. However, 65% of these patients will
develop tumor progression in the first three years after diagnosis.
Over the past ten years, the only improvement in
overall survival has been reported with the introduction of
a dose dense schedule of paclitaxel (9) or by the use of local
ip treatment in selected patients (10); the addition of a
third cytotoxic to standard chemotherapy has not showed
any significant advantage over the established first-line
chemotherapy (11, 12).