Progression-free survival similar to IP, IV therapy; higher risk of bowel perforation/obstruction
WEDNESDAY, Nov. 9 (HealthDay News) -- Addition of bevacizumab to first-line intraperitoneal (IP) chemotherapy is feasible in ovarian cancer but increases the risk of bowel obstruction/perforation, according to a study published online Nov. 7 in the Journal of Clinical Oncology.
Jason A. Konner, M.D., from the Memorial Sloan-Kettering Cancer Center in New York City, and colleagues assessed the safety and feasibility of adding bevacizumab to a first-line IP regimen in 41 patients with optimally debulked ovarian cancer. Patients were treated with intravenous (IV) paclitaxel 135 mg/m² (over three hours on day one), cisplatin 75 mg/m² IP (on day two), and paclitaxel 60 mg/m² IP (on day eight). Beginning in cycle two, bevacizumab 15 mg/kg IV was given after paclitaxel (on day one). Bevacizumab was given every three weeks for 17 additional treatments after six cycles of chemotherapy. Safety and tolerability of the regimen was measured by whether 60 percent of the patients completed six cycles of IV/IP chemotherapy.
The investigators found that 30 and 35 patients received six and at least four cycles of IV/IP chemotherapy, respectively. Three patients discontinued chemotherapy due to bevacizumab-related complications. Grade 3 and 4 toxicities included neutropenia, vasovagal syncope, hypertension, nausea/vomiting, hypomagnesemia, and abdominal pain; and three grade 3 small bowel obstructions were seen (during cycles three, nine, and 15). IP port malfunction was observed in three patients. There was one death following rectosigmoid anastomotic dehiscence in cycle four. The estimated median progression-free survival (PFS) of the cohort was 28.6 months.
"The addition of bevacizumab to this IP regimen is feasible; however, bevacizumab may increase the risk of bowel obstruction/perforation. The observed median PFS is similar to that seen with IP/IV chemotherapy alone," the authors write.
One of the study authors disclosed a financial relationship with Genentech, which partially funded the study and manufactures bevacizumab.
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