title: Bevacizumab in the treatment of ovarian cancer.
abstract: BACKGROUND
  In the past decade there have been many attempts to improve systemic treatment and thus the outcome of patients with ovarian cancer. However, neither the sequential addition of non cross-resistant drugs to standard chemotherapy comprising carboplatin and paclitaxel, nor triplet combination therapies with conventional chemotherapeutic drugs have improved outcomes. Instead, such approaches have led to an increase in the incidence of side effects. We are currently experiencing a shift toward the addition of molecularly targeted and biological anticancer therapies to standard treatment. Vascular endothelial growth factor (VEGF), which improves vitally important tumor vasculature, is secreted by a range of tumors, and a high level of VEGF is known to be an independent risk factor for aggressive disease in ovarian cancer. This finding led to the development in the 1990s of bevacizumab, a humanized monoclonal antibody against VEGF.
  
  
  CONCLUSIONS
  Several phase II trials and four phase III trials have demonstrated that bevacizumab is active in patients with advanced and recurrent ovarian cancer. Both phase III trials of bevacizumab as first-line therapy in advanced ovarian cancer (ICON 7/AGOOVAR 11 and GOG-0218) have shown that the addition of bevacizumab to chemotherapy and as maintenance therapy improves progressionfree survival (PFS). The phase III trials in platinum-sensitive (OCEANS) and platinumresistant, relapsed disease (AURELIA) have also demonstrated a benefit for bevazicumab with respect to PFS. The administration of bevacizumab to improve survival in patients with ovarian cancer is not without side effects and a broad discussion on the cost-effectiveness of this approach is ongoing.
  
  
  CONCLUSIONS
  This article presents clinical trial data on bevacizumab in the treatment of ovarian cancer and discusses the indication and pitfalls in the application of bevacizumab in patients with this malignancy.
authors.affiliation: Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte, Evangelische Huyssen-Stiftung, Henricistrasse 92, 45136, Essen, Germany. florian.heitz@gmx.net
authors.forename: Florian
authors.initials: F
authors.lastname: Heitz
authors.forename: Philipp
authors.initials: P
authors.lastname: Harter
authors.forename: Jana
authors.initials: J
authors.lastname: Barinoff
authors.forename: Bianca
authors.initials: B
authors.lastname: Beutel
authors.forename: Paevi
authors.initials: P
authors.lastname: Kannisto
authors.forename: Jacek P
authors.initials: JP
authors.lastname: Grabowski
authors.forename: Julia
authors.initials: J
authors.lastname: Heitz
authors.forename: Christian
authors.initials: C
authors.lastname: Kurzeder
authors.forename: Andreas
authors.initials: A
authors.lastname: du Bois
mesh_terms: D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D000068258:Bevacizumab; D002277:Carcinoma / Q000188:drug therapy*; D005260:Female; D006801:Humans; D010051:Ovarian Neoplasms / Q000188:drug therapy*
chemical_list: D020533:Angiogenesis Inhibitors; D061067:Antibodies, Monoclonal, Humanized; D000068258:Bevacizumab