Ovarian cancer (advanced): bevacizumab 7.5 mg/kg in combination with paclitaxel and carboplatin for first-line treatment

How well does bevacizumab work?

One large study has looked at how well bevacizumab works in treating advanced ovarian cancer at half the licensed dose. It looked at how effective bevacizumab was when added to the usual chemotherapy drugs, compared with chemotherapy alone.

The results showed that the addition of bevacizumab to chemotherapy could delay the return or further spread of the disease by around 1 to 2 months (from an average of just over 17 months with usual chemotherapy to 19 months with the addition of bevacizumab). The study has not finished so not all the results are complete. Early results also showed it might improve survival by nearly 8 months in certain people with high risk advanced ovarian cancer (from an average of almost 29 months to about 37 months). However, these benefits might be different (possibly smaller) when the full results are published. These are average results and do not mean that bevacizumab would benefit everyone with advanced ovarian cancer to the same extent. Some people would get less benefit than the average, and others would get more benefit than the average.

What are the possible harms or side effects?

The list of different side effects is very long. All women in the trial who were given bevacizumab had at least 1 side effect.

Of the women in the trial given bevacizumab, a quarter developed high blood pressure. Some of the more serious side effects included developing holes in the gut wall, and developing fistulas (abnormal passage ways between 2 organs or parts of the body), but this only happened in about 1 out of 100 women in trial. It caused bleeding (such as nose bleeds) in a third of the women. It also caused bleeding in other parts of the body such as the brain but this was rare, and happened in less than 1 out of 100 women. It can cause blood clots, which happened in 1 out of 10 women in the trial. It also made it difficult for wounds to heal in 1 out of 20 women in the trial.

Like other treatments for cancer, bevacizumab can reduce the number of white blood cells making it harder to fight infections. Recently it has been linked to a severe deep skin infection called necrotising fasciitis and to a bone condition called osteonecrosis of the jaw, but these side effects are rare.

The study also looked at quality of life using questionnaires that were filled out every few months. It looked at how well the women felt physically and emotionally and how well they were able to carry out normal day-to-day activities. It found that women had a slightly worse quality of life if they had bevacizumab as well as usual chemotherapy compared with usual chemotherapy alone.