title: Bevacizumab toxicity in heavily pretreated recurrent epithelial ovarian, fallopian tube, and primary peritoneal cancers.
abstract: OBJECTIVE
  Bevacizumab was recently approved by the US Food and Drug Administration for use in recurrent platinum resistant epithelial ovarian cancer (EOC), fallopian tube cancer (FTC), or primary peritoneal cancer (PPC) when no more than two prior cytotoxic regimens have been used; due to concerns for gastrointestinal perforation. We sought to determine bevacizumab-related toxicities in heavily pretreated recurrent EOC.
  
  
  METHODS
  We performed a retrospective chart review of patients with recurrent EOC, FTC, and PPC from 2001 to 2011. Patients who received at least two prior chemotherapy regimens before bevacizumab were included. Medical records were reviewed for bevacizumab associated toxicities. The Wilcoxon-Mann-Whitney test was used to compare quantitative variables. Survival was estimated with the Kaplan-Meier method.
  
  
  RESULTS
  Sixty patients met inclusion criteria. At the start of bevacizumab treatment, the median age was 60 years and the median body mass index was 26.5 kg/m². More than 50% of patients received bevacizumab after three prior cytotoxic regimens. Grade 3 or higher bevacizumab associated toxicity events occurred in four patients, including one patient who developed a rectovaginal fistula. The median overall survival from the start of bevacizumab treatment was 21.05 months (95% CI, 18.23 to 32.67; range, 1.9 to 110 months). The number of cytotoxic regimens prior to bevacizumab treatment did not differ in those that experienced a toxicity versus those that did not (p=0.66).
  
  
  CONCLUSIONS
  The use of bevacizumab in heavily pretreated EOC, FTC, or PPC is worth consideration.
authors.affiliation: Division of Gynecologic Oncology, University of Washington Medical Center, Seattle, WA, USA. jymartin@uw.edu.
authors.forename: Jovana Y
authors.identifier: http://orcid.org/0000-0002-6564-3790
authors.initials: JY
authors.lastname: Martin
authors.affiliation: Division of Gynecologic Oncology, University of Washington Medical Center, Seattle, WA, USA.
authors.forename: Renata R
authors.identifier: http://orcid.org/0000-0001-8967-3794
authors.initials: RR
authors.lastname: Urban
authors.affiliation: Division of Gynecologic Oncology, University of Washington Medical Center, Seattle, WA, USA.
authors.forename: John B
authors.identifier: http://orcid.org/0000-0002-3018-7879
authors.initials: JB
authors.lastname: Liao
authors.affiliation: Division of Gynecologic Oncology, University of Washington Medical Center, Seattle, WA, USA.
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Goff
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D000068258:Bevacizumab / Q000009:adverse effects*; D000077216:Carcinoma, Ovarian Epithelial; D005185:Fallopian Tube Neoplasms / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007416:Intestinal Perforation / Q000139:chemically induced; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy*; D009375:Neoplasms, Glandular and Epithelial / Q000188:drug therapy*; D010051:Ovarian Neoplasms / Q000188:drug therapy*; D010534:Peritoneal Neoplasms / Q000188:drug therapy*; D012189:Retrospective Studies
chemical_list: D020533:Angiogenesis Inhibitors; D000068258:Bevacizumab
keywords: Bevacizumab; Drug Resistance; Gastrointestinal Diseases; Ovarian Neoplasms; Recurrence; Survival Analysis