Bevacizumab as maintenance treatment in BRCA mutated patients with advanced ovarian cancer: A large, retrospective, multicenter case-control study

• Published in: Gynecologic oncology Vol. 159; no. 1; pp. 95 - 100
• Main Authors: Lorusso, D., Marchetti, C., Conte, C., Giudice, E., Bolomini, G., Vertechy, L., Ceni, V., Ditto, A., Ferrandina, G., Raspagliesi, F., Scambia, G., Fagotti, A.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-10-2020
• Subjects: Adult; Aged; Aged, 80 and over; Angiogenesis Inhibitors - administration & dosage; Angiogenesis Inhibitors - adverse effects; Antiangiogenic therapy; Antineoplastic Combined Chemotherapy Protocols - administration & dosage; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Bevacizumab; Bevacizumab - administration & dosage; Bevacizumab - adverse effects; BRCA; BRCA1 Protein - genetics; BRCA2 Protein - genetics; Carboplatin - administration & dosage; Carboplatin - adverse effects; Case-Control Studies; Chemotherapy, Adjuvant - adverse effects; Chemotherapy, Adjuvant - methods; Cytoreduction Surgical Procedures; Disease Progression; Female; Humans; Maintenance Chemotherapy - adverse effects; Maintenance Chemotherapy - methods; Maintenance therapy; Middle Aged; Mutation; Ovarian cancer; Ovarian Neoplasms - diagnosis; Ovarian Neoplasms - genetics; Ovarian Neoplasms - mortality; Ovarian Neoplasms - therapy; Ovary - drug effects; Ovary - pathology; Ovary - surgery; Paclitaxel - administration & dosage; Paclitaxel - adverse effects; Parp inhibitors; Progression-Free Survival; Retrospective Studies; FDA; PS; BRCAmut; BRCAwt; FIGO; Ovarian cancer; Bevacizumab; AUC; HGSOC; mOS; OC; Q3W; Antiangiogenic therapy; AOC; ECOG; IDS; PARPi; PFS; PDS; mPFS; OS; CP; TCGA; Parp inhibitors; BRCA; ORs; Bev; Maintenance therapy; SGO; HRD; TILs
• ISSN: 0090-8258; 1095-6859
• DOI: 10.1016/j.ygyno.2020.07.022

The aim of this study was to investigate the correlation between BRCA mutational status and response to bevacizumab in a large advanced ovarian cancer (AOC) series.
This is a multicenter, retrospective case-control study including upfront AOC treated between January 2015 and June 2019. The main inclusion criteria were: having received three weekly carboplatin-paclitaxel as first-line treatment, with or without Bevacizumab maintenance, knowledge of the BRCA mutational status.
Overall, 441 patients were included; 183 (41.5%) patients received bevacizumab (Cases), and 258 (58.5%) did not receive it (Controls). The BRCA mutated patients (BRCAmut) were 58 (39%) in the Cases group and 90 (34.9%) in the Controls group (p = .77).
Patients who received bevacizumab had a significant 4-months increase in median progression free survival (mPFS: 21 vs. 17 months, p = .033). Concerning BRCAmut patients, no differences were shown between those who received bevacizumab or not in terms of mPFS (24 vs. 22 months, p = .3). Conversely, in BRCA wild-type (BRCAwt) population bevacizumab administration significantly prolonged mPFS (20 vs 15 months, p = .019). At multivariate analysis, independent factors of prolonged PFS were BRCA status (OR = 0.60), having received PDS (OR = 0.69), and complete cytoreduction (OR = 0.50), but not the bevacizumab administration (OR = 0.83, p = .22).
No evidence of oncological benefit in terms of PFS and OS related to bevacizumab maintenance therapy was found in BRCAmut patients. Differently, BRCAwt patients seem to benefit from antiangiogenic treatment in terms of mPFS.
•To investigate the efficacy of bevacizumab according to BRCA mutational status in advanced ovarian cancer patients.•The BRCA mutated patients did not benefit from antiangiogenic maintenance treatment in terms of PFS and OS.•The bevacizumab administration significantly prolonged PFS in the BRCA wild-type population, whereas did not improve OS.