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Gynecol Oncol. 2015 Oct;139(1):17-22. doi: 10.1016/j.ygyno.2015.07.103. Epub 2015 Jul 26.

Ascites predicts treatment benefit of bevacizumab in front-line therapy of advanced epithelial ovarian, fallopian tube and peritoneal cancers: an NRG Oncology/GOG study.

Author information

1
Temple University School of Medicine & Fox Chase Cancer Center, Philadelphia, PA, United States.
2
Gynecologic Oncology Group Statistical & Data Center, Buffalo, NY, United States.
3
Arizona Oncology, Tucson, AZ, United States.
4
University of Chicago Medical Center, Chicago, IL, United States.
5
St Joseph's Hospital, Creighton School of Medicine, Phoenix, AZ, United States.
6
University of Oklahoma, Oklahoma City, OK, United States.
7
Gynecologic Oncology Group, Buffalo, NY, United States.
8
Ohio State University, Columbus, OH, United States.
9
University of Washington, Seattle, WA, United States.
10
Minnesota Oncology, Edina, MN, United States.
11
University of Pennsylvania, Philadelphia, PA, United States. Electronic address: burgerr@uphs.upenn.edu.

Abstract

OBJECTIVES:

Predictive factors for efficacy of bevacizumab in advanced ovarian cancer have remained elusive. We investigated ascites both as a prognostic factor and as a predictor of efficacy for bevacizumab.

METHODS:

Using data from GOG 0218, patients receiving cytotoxic therapy plus concurrent and maintenance bevacizumab were compared to those receiving cytotoxic therapy plus placebo. The presence of ascites was determined prospectively. Chi-square and Wilcoxon-Mann-Whitney tests compared baseline variables between subgroups. Survival was estimated by Kaplan-Meier method, and Cox proportional hazard models were used to evaluate independent prognostic factors and estimate their covariate-adjusted effects on survival.

RESULTS:

Treatment arms were balanced with respect to ascites and other prognostic factors. Overall, 886 (80%) women had ascites, 221 (20%) did not. Those with ascites were more likely to have: poorer performance status (p<0.001); serous histology (p=0.012); higher baseline CA125 (p<0.001); and suboptimal cytoreduction (p=0.004). In multivariate survival analysis, ascites was prognostic of poor OS (Adjusted HR 1.22, 95% CI 1.00-1.48, p=0.045), but not PFS. In predictive analysis, patients without ascites treated with bevacizumab had no significant improvement in either PFS (AHR 0.81, 95% CI 0.59-1.10, p=0.18) or OS (AHR 0.94, 95% CI 0.65-1.36, p=0.76). Patients with ascites treated with bevacizumab had significantly improved PFS (AHR 0.71, 95% CI 0.62-0.81, p<0.001) and OS (AHR 0.82, 95% CI 0.70-0.96, p=0.014).

CONCLUSIONS:

Ascites in women with advanced ovarian cancer is prognostic of poor overall survival. Ascites may predict the population of women more likely to derive long-term benefit from bevacizumab.

KEYWORDS:

Advanced epithelial ovarian cancer; Bevacizumab; Front-line therapy; GOG; NRG Oncology

PMID:
26216729
PMCID:
PMC4600605
DOI:
10.1016/j.ygyno.2015.07.103
[Indexed for MEDLINE]
Free PMC Article

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