Advice
Intervention and alternatives
Bevacizumab is a humanised monoclonal antibody that inhibits vascular endothelial growth factor (VEGF) angiogenesis. This reduces vascularisation of tumours, thereby inhibiting tumour growth. It is used in combination with chemotherapy, given through intravenous infusion.
Condition
Cancer research UK indicates ovarian cancer is the fifth most common cancer in women in the UK, and epithelial ovarian cancer accounts for almost 90% of cases. Most cases occur after the menopause, and 10% are caused by an inherited faulty gene. There is no accurate and reliable screening test as yet and early symptoms are absent or vague, including lower abdominal pain or bloating, urinary frequency or urgency, dyspareunia and postmenopausal bleeding. Advanced symptoms include loss of appetite, nausea, vomiting, fatigue and shortness of breath. Ovarian cancer: the recognition and initial management of ovarian cancer (NICE clinical guideline 122) reports the 5-year survival rate for women with ovarian cancer as being less than 35% because most women present with advanced disease.
Alternative treatment options
The NICE clinical guideline on ovarian cancer recommends that low-risk FIGO stage 1 disease (confined to the ovaries, grade 1 or 2, stage 1a or 1b) is treated surgically. It also recommends that adjuvant chemotherapy is offered to women with high-risk stage 1 disease (grade 3 or stage 1c) or to those who have had suboptimal surgical staging. According to Bevacizumab in combination with paclitaxel and carboplatin for first-line treatment of advanced ovarian cancer (NICE technology appraisal guidance 284), chemotherapy with paclitaxel and carboplatin is the current standard clinical practice in the NHS in England and Wales for first-line treatment of advanced ovarian cancer (FIGO stages II–IV) after debulking surgery. It states that 3 cycles of chemotherapy may be given before surgery for some patients expected to have residual disease left after surgery.