Anti-angiogenesis therapy with bevacizumab for patients with ovarian granulosa cell tumors.
OBJECTIVE
Ovarian granulosa cell tumors tend to respond poorly to chemotherapy. We examined the clinical efficacy of bevacizumab with or without concurrent chemotherapy and evaluated the angiogenic characteristics of these patients' tumors.


METHODS
We conducted a retrospective review of all patients seen at our institution from February 2004 to October 2008 who received bevacizumab for ovarian sex cord-stromal tumors. We performed immunohistochemical staining for vascular endothelial growth factor (VEGF) and CD31 when tissue was available; microvessel density was measured based on CD31 staining. Clinical data were abstracted from a chart review.


RESULTS
We identified 8 patients who were treated with bevacizumab; 7 had adult granulosa cell tumors and one had a juvenile granulosa cell tumor. All patients had recurrent disease and had been previously treated with cytotoxic chemotherapy (median 3.5 regimens; range, 1-6). One patient had a complete clinical response to bevacizumab therapy, 2 patients had a partial response, 2 patients had stable disease, and 3 patients' disease progressed, yielding a response rate of 38% and a clinical benefit rate of 63%. The median progression-free survival was 7.2 months and overall survival was not reached at a median follow-up of 23.6 months after initiating bevacizumab. VEGF overexpression and microvessel density were associated with poor outcome but sample size was too small to calculate statistical significance.


CONCLUSIONS
Anti-VEGF therapy is highly effective in patients with granulosa cell tumors. Based on our observations, a prospective trial has been initiated using single-agent bevacizumab in patients with recurrent ovarian sex cord-stromal tumors.
Tao
Xia
X
Department of Gynecologic Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030-1439, USA.
Sood
Anil K
AK
Deavers
Michael T
MT
Schmeler
Kathleen M
KM
Nick
Alpa M
AM
Coleman
Robert L
RL
Milojevic
Ljiljana
L
Gershenson
David M
DM
Brown
Jubilee
J
D000328:Adult; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D000068258:Bevacizumab; D005260:Female; D006106:Granulosa Cell Tumor / Q000098:blood supply* / Q000188:drug therapy*; D006801:Humans; D007150:Immunohistochemistry; D008875:Middle Aged; D009389:Neovascularization, Pathologic / Q000188:drug therapy / Q000378:metabolism; D010051:Ovarian Neoplasms / Q000098:blood supply* / Q000188:drug therapy* / Q000378:metabolism; D019408:Platelet Endothelial Cell Adhesion Molecule-1 / Q000378:metabolism; D012189:Retrospective Studies; D042461:Vascular Endothelial Growth Factor A / Q000378:metabolism; D055815:Young Adult
D020533:Angiogenesis Inhibitors; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D019408:Platelet Endothelial Cell Adhesion Molecule-1; D042461:Vascular Endothelial Growth Factor A; D000068258:Bevacizumab