Feasibility of Surgery After Systemic Treatment with the Humanized Recombinant Antibody Bevacizumab in Heavily Pretreated Patients with Advanced Epithelial Ovarian Cancer
- 238 Downloads
The aim of this study was to assess operative feasibility and outcome after bevacizumab treatment (BT) in ovarian cancer (OC) patients.
Patients and Methods
We retrospectively identified all OC patients operated between April 2006 and September 2010 after BT.
We identified 733 OC operations, 10 of which (1.36%) were performed in a mean time of 134 days (range, 10–288) after BT. Indication was secondary cytoreduction in 3 patients (mean days after BT, 181; range, 82–256) and palliation in 7 due to bowel obstruction and/or intestinal perforation or fistula (mean days after BT, 114; range, 10–288). All but 1 acutely operated patients developed a secondary wound healing, but none of the 3 patients after planned cytoreduction did. Of these 3 patients, 1 suddenly died on the 36th postoperative day, presumably of thromboembolism. None of the patients developed postoperatively a gastrointestinal morbidity; however, in 1 patient operated 21 days after BT due to a vesicointestinal fistula the bladder reconstruction could not heal and developed a permanent fistula.
Emergency surgery after BT due to bowel obstruction and/or fistulas seems to be associated with an impaired wound healing in advanced heavily pretreated platinum-resistant OC patients, while this does not appear the case in planned cytoreduction. Prospective evaluations are warranted to assess surgical safety after BT in this special patients’ collective.
KeywordsBevacizumab Ovarian Cancer Patient Short Bowel Syndrome Recurrent Ovarian Cancer Bevacizumab Treatment
- 6.Sfakianos GP, Numnum TM, Halverson CB, Panjeti D, Kendrick JE 4th, Straughn JM Jr. The risk of gastrointestinal perforation and/or fistula in patients with recurrent ovarian cancer receiving bevacizumab compared to standard chemotherapy: a retrospective cohort study. Gynecol Oncol. 2009;114:424–6.PubMedCrossRefGoogle Scholar
- 13.Reddy SK, Morse MA, Hurwitz HI, Bendell JC, Gan TJ, Hill SE, et al. Addition of bevacizumab to irinotecan- and oxaliplatin-based preoperative chemotherapy regimens does not increase morbidity after resection of colorectal liver metastases. J Am Coll Surg. 2008;206:96–106.PubMedCrossRefGoogle Scholar
- 14.Kristensen G, Perren T, Qian W, Pfisterer J, Ledermann JA, Joly F, et al. Result of interim analysis of overall survival in the GCIG ICON7 phase III randomized trial of bevacizumab in women with newly diagnosed ovarian cancer. J Clin Oncol. 2011;29:LBA5006.Google Scholar
- 15.Harter P, Hahmann M, Lueck HJ, Poelcher M, Wimberger P, Ortmann O, et al. Surgery for recurrent ovarian cancer: role of peritoneal carcinomatosis: exploratory analysis of the DESKTOP I Trial about risk factors, surgical implications, and prognostic value of peritoneal carcinomatosis. Ann Surg Oncol. 2009;16:1324–30.PubMedCrossRefGoogle Scholar
- 18.Adhesion Scoring Group, Improvement of interobserver reproducibility of adhesion scoring systems. Fertil Steril. 1994;62:984–8.Google Scholar
- 19.Cohen Z, Senagore AJ, Dayton MT, Koruda MJ, Beck DE, Wolff BG, et al. Prevention of postoperative abdominal adhesions by a novel, glycerol/sodium hyaluronate/carboxymethylcellulose–based bioresorbable membrane: a prospective, randomized, evaluator-blinded multicenter study. Dis Colon Rectum. 2005;48:1130–9.PubMedCrossRefGoogle Scholar
- 20.International Federation of Gynecology and Obstetrics. Changes in definitions of clinical staging for carcinoma of the cervix and ovary. Am J Obstet Gynecol. 1987:156:263–4.Google Scholar
- 21.Pietzner K, Schmuck RB, Fotopoulou C, Gellermann J, Ismaeel F, Cho CH, et al. Long term combination treatment with bevacizumab, pegylated liposomal Doxorubicin and regional abdominal hyperthermia in platinum refractory ovarian cancer: a case report and review of the literature. Anticancer Res. 2011;31:2675–7.PubMedGoogle Scholar
- 31.Khasraw M, Holodny A, Goldlust SA, Deangelis LM. Intracranial hemorrhage in patients with cancer treated with bevacizumab: the Memorial Sloan-Kettering experience. Ann Oncol. 2011 May 4 [Epub ahead of print].Google Scholar
- 36.Basbug M, Bulbuller N, Camci C, Ayten R, Aygen E, Ozercan IH, et al. The effect of antivascular endothelial growth factor on the development of adhesion formation in laparotomized rats: experimental study. Gastroenterol Res Pract. 2011;2011:578691 [Epub June 28 2011].Google Scholar
- 42.Cannistra SA, Matulonis UA, Penson RT, Hambleton J, Dupont J, Mackey H, et al. Phase II study of bevacizumab in patients with platinum-resistant ovarian cancer or peritoneal serous cancer. J Clin Oncol. 2007;25:5180–6. Erratum in: J Clin Oncol. 2008;26:1773.Google Scholar