Use of bevacizumab for patients with International Federation of Gynecology and Obstetrics stage IIIB to IV epithelial ovarian cancer undergoing primary debulking surgery and its association with oncologic outcomes: a Cancer Registry study

OBJECTIVE: We aimed to evaluate the use of bevacizumab in patients with International Federation of Gynecology and Obstetrics stage IIIB to IV epithelial ovarian and fallopian tube cancer undergoing primary debulking surgery, using real-world data from a German cancer registry. METHODS: Patients with a first diagnosis of International Federation of Gynecology and Obstetrics stage IIIB to IV epithelial ovarian or fallopian tube cancer diagnosed between 2009 and 2023 were identified from the Baden-Wuerttemberg Cancer Registry. Outcomes of patients receiving carboplatin and paclitaxel±bevacizumab were compared. Progression-free survival and overall survival were analyzed using multivariable Cox regression, adjusting for age, grade, stage, poly adenosine diphosphate-ribose polymerase (PARP) inhibitor use, and surgical outcome. Sub-group analyses were performed according to residual disease, categorized as optimal debulking or sub-optimal debulking, and by PARP inhibitor use. RESULTS: Among 1469 patients (median follow-up 37.8 months), 969 (66%) had stage IIIB/C and 500 (34%) stage IV disease. Optimal debulking was achieved in 842 patients (57.3%). Overall, 54.5% received carboplatin+paclitaxel+bevacizumab: 54.2% with optimal and 52.3% with sub-optimal debulking. Bevacizumab improved progression-free survival (hazard ratio [HR] 0.78, 95% confidence interval [CI] 0.65 to 0.93) and overall survival (HR 0.79, 95% CI 0.65 to 0.96) in suboptimal debulking, but not in optimal debulking (overall survival HR 0.88, 95% CI 0.72 to 1.1; progression-free survival HR 0.91, 95% CI 0.76 to 1.1). Sub-group analyses suggested PARP inhibitor therapy may obscure or outweigh bevacizumab's impact. CONCLUSIONS: Bevacizumab is frequently used in primary debulking surgery for advanced ovarian cancer. Survival benefits are mainly observed in patients with residual disease, while PARP inhibitor therapy may influence these effects. Real-world evidence complements clinical trials and informs treatment decisions.