Retreatment with bevacizumab in patients with gynecologic malignancy is associated with clinical response and does not increase morbidity.
OBJECTIVE
Bevacizumab (Bev) is associated with improved progression-free survival in advanced epithelial ovarian cancer. The use of Bev in patients with gynecologic malignancy is increasing; however, little is known about cumulative toxicity and response in patients retreated with Bev. Our goal was to determine cumulative side effects and response in patients retreated with Bev.


METHODS
Women with recurrent gynecologic malignancy treated with Bev between January 2007 and March 2012 at a single institution were identified, including a subset who received Bev in a subsequent regimen. The primary outcome was Bev-associated toxicity, and the secondary outcome was response.


RESULTS
Of 83 patients that received Bev for recurrent disease, 23 were retreated with Bev and four received Bev maintenance. Three patients (13%) developed grade 3 or 4 hypertension; all had a history of chronic hypertension. One (4.3%) patient developed grade 3 proteinuria, and one (4.3%) developed an enterovaginal fistula. Four patients discontinued Bev secondary to toxicity. Toxicity was not related to the cumulative number of cycles. Twenty-six percent of patients responded to Bev retreatment. On univariate analysis, there was a significant (P=0.003) overall survival advantage when the Bev-free interval was >9 months (95% confidence interval [CI] 4.9-43.7) compared to ≤9 months (95% CI 2.1-11.5), 24.3 months, and 6.8 months.


CONCLUSIONS
Retreatment of patients with recurrent gynecologic malignancy with Bev did not increase morbidity and was associated with treatment response. Physicians treating women with recurrent disease may consider a Bev-containing regimen even if prior regimen(s) included Bev. Future studies should prospectively evaluate the efficacy of this treatment strategy.
Division of Gynecologic Oncology, Magee-Womens Hospital of UPMC, Pittsburgh, PA, USA.
Robin A
RA
Laskey
Division of Gynecologic Oncology, Drexel University College of Medicine/Hahnemann University Hospital, Philadelphia, PA, USA.
Scott D
SD
Richard
Division of Gynecologic Oncology, Magee-Womens Hospital of UPMC, Pittsburgh, PA, USA.
Ashlee L
AL
Smith
Division of Gynecologic Oncology, Magee-Womens Hospital of UPMC, Pittsburgh, PA, USA.
Jeff F
JF
Lin
Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Hospital of UPMC, Pittsburgh, PA, USA.
Tiffany L
TL
Beck
Division of Gynecologic Oncology, Magee-Womens Hospital of UPMC, Pittsburgh, PA, USA.
Jamie L
JL
Lesnock
Division of Gynecologic Oncology, Magee-Womens Hospital of UPMC, Pittsburgh, PA, USA.
Joseph L
JL
Kelley
Division of Gynecologic Oncology, Magee-Womens Hospital of UPMC, Pittsburgh, PA, USA.
Alexander B
AB
Olawaiye
Division of Gynecologic Oncology, Magee-Womens Hospital of UPMC, Pittsburgh, PA, USA.
Paniti
P
Sukumvanich
Division of Gynecologic Oncology, Western Pennsylvania Hospital, Pittsburgh, PA, USA.
Thomas C
TC
Krivak
bevacizumab; cumulative toxicity; gynecologic malignancy; treatment response