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European Journal of Gynaecological Oncology  2020, Vol. 41 Issue (3): 364-367    DOI: 10.31083/j.ejgo.2020.03.5267
Original Research Previous articles | Next articles
Bevacizumab in combination with metronomic oral cyclophosphamide: an effective and well-tolerated treatment for patients with recurrent ovarian cancer
C.J. Heesterbeek1, 2(), A.M. Thijs1, R.H.M. Hermans3, D. Boll3, G.-J. Creemers1
1Department of Medical Oncology, Catharina Hospital, Eindhoven, the Netherlands
2Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands
3Department of Gynaecology, Catharina Hospital, Eindhoven, the Netherlands
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Abstract  

Purpose of Investigation: In this study the authors describe their clinical experience with metronomic oral cyclophosphamide and bevacizumab in terms of efficacy and tolerability in patients with recurrent ovarian cancer beyond first-line treatment. Materials and Methods: This retrospective, descriptive study included 59 patients with recurrent ovarian cancer. They were treated with intravenous bevacizumab (10 mg/kg, once every three weeks) in combination with oral cyclophosphamide (100 mg once daily). Patients had received at least one line of platinum-based chemotherapy prior to combined bevacizumab and cyclophosphamide treatment. Both platinum sensitive patients and platinum resistant patients were included. Results: Treatment with combined bevacizumab and cyclophosphamide was administered as a third line therapy in 42.4% of patients. The median number of cycles of bevacizumab administered with oral cyclophosphamide was 7 (range 1-40). A response was demonstrated in 37 (62.7%) patients, with a median progression free survival of 6 months (range 0-44). No toxicity was recorded in the medical report of 39% of patients, with only mild toxicities reported in the others. Conclusion: Bevacizumab combined with metronomic cyclophosphamide appears to be a well-tolerated and effective therapy with sustainable remissions in this selective group heavily pretreated ovarian cancer patients. This regimen should be considered in patients who are not suitable or have no need for more toxic systemic treatment.

Key words:  Ovarian cancer      Bevacizumab      Cyclophosphamide      Metronomic therapy     
Submitted:  26 May 2019      Accepted:  08 August 2019      Published:  15 June 2020     
*Corresponding Author(s):  C.J. Heesterbeek     E-mail:  karin.heesterbeek@mumc.nl

Cite this article: 

C.J. Heesterbeek, A.M. Thijs, R.H.M. Hermans, D. Boll, G.-J. Creemers. Bevacizumab in combination with metronomic oral cyclophosphamide: an effective and well-tolerated treatment for patients with recurrent ovarian cancer. European Journal of Gynaecological Oncology, 2020, 41(3): 364-367.

URL: 

https://ejgo.imrpress.com/EN/10.31083/j.ejgo.2020.03.5267     OR     https://ejgo.imrpress.com/EN/Y2020/V41/I3/364

Table 1  - Baseline characteristics
Patients N=59
Age at primary diagnosis (years)
Median (range) 65 (38-84)
FIGO stage at diagnosis
I, II 4
IIIA 1
IIIB 5
IIIC 32
IV 17
Histology
Serous 47
Mucinous 1
Endometrio?d 3
Adenocarcinoma no other specified 6
Unknown 2
Prior debulking
Yes 49
No 10
Initial platinum response
Primary platinum sensitive 43
Primary platinum resistant 13
Primary platinum refractory 3
Figure 1.  — Cyclophosphamide and bevacizumab treatment details. *Based on platinum sensitivity after completing first line platinum based chemotherapy.

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