Bevacizumab Efficacy and Tolerability in Patients with Metastatic Platinum-Sensitive Ovarian Cancer Beyond Progression

High recurrence rates and the emergence of resistance mechanisms in ovarian cancer necessitate exploring alternative therapeutic strategies except platinum-based chemotherapies. This has led to the development of bevacizumab, a recombinant humanized monoclonal antibody targeting VEGF. Nevertheless, the continuation of bevacizumab treatment initiated alongside chemotherapy, especially after disease progression, remains a topic of debate. Our study involved a single-center retrospective analysis of the medical records of patients diagnosed with stage 3 and 4 epithelial ovarian cancer between June 2011 and January 2023. All patients in our study were platinum-sensitive. Patients with residual disease >1 cm following initial surgery had significantly worse median OS (p = 0.002). Post-progression, patients were divided into two groups based on whether bevacizumab was continued. More than half of the patients who continued treatment with bevacizumab and chemotherapy achieved a 5-year OS, which was statistically superior (p < 0.001). When comparing PFS between patients who did and did not receive bevacizumab in the second line following recurrence/progression, those treated with bevacizumab demonstrated a median PFS of 12.0 months (95% CI: 10.5-13.4), which was significantly better (p < 0.001). The hazard ratio for mortality in patients continuing bevacizumab treatment beyond progression was 0.11 (95% CI: 0.05-0.22) (p < 0.001). Many studies have shown the effectiveness and survival benefit of bevacizumab in epithelial ovarian cancer. In contrast, the literature offers limited studies addressing the survival benefits of continuing bevacizumab beyond disease progression. However, our study indicates that continuing bevacizumab beyond progression significantly contributes to both OS (p < 0.001) and PFS (p < 0.001). As larger studies with similar results to ours are conducted in the future, current guidelines may improve, and the decision to continue bevacizumab treatment after progression may become more evidence-based.