Oral cyclophosphamide combined with bevacizumab in recurrent heavily pre-treated ovarian cancer.

OBJECTIVE

Bevacizumab combined with oral cyclophosphamide has demonstrated activity in recurrent ovarian cancer, but data in heavily pre-treated high-grade disease are limited. We evaluated the safety and efficacy of this combination regimen in this setting.

METHODS

We conducted a retrospective review of patients with recurrent high-grade epithelial ovarian cancer treated with oral cyclophosphamide (50 mg daily) and bevacizumab (15 mg/kg every 3 weeks) at a single institution. Objective response rate was defined as complete or partial response. Progression-free survival was estimated using the Kaplan-Meier method, and adverse events were graded per Common Terminology Criteria for Adverse Events version 5.0.

RESULTS

Among 100 patients (median age 58 years; range; 38-80), 94% had high-grade serous histology and 96% had stage IIIC to IV disease. Fourteen (14%) were platinum-sensitive and 86 (86%) platinum-resistant, with a median of 3 prior treatment lines (range; 1-9). Patients received a median of 5 cycles (range; 2-34). The objective response rate was 40% (95% confidence interval 31 to 51), including 4% complete and 36% partial responses; 20% achieved stable disease. Response did not differ by prior bevacizumab exposure (36% vs 43%, p = .59) or platinum sensitivity status. Median progression-free survival was 4.6 months (95% confidence interval 3.4 to 5.9). Twenty-four (24%) patients experienced adverse events. The most common grade 3 or 4 toxicities included hypertension (3%), thrombocytopenia (3%), and hemorrhagic cystitis (1%).

CONCLUSIONS

Bevacizumab combined with oral cyclophosphamide demonstrated meaningful activity and manageable toxicity in heavily pre-treated high-grade ovarian cancer, supporting its use as a feasible treatment option.