Bevacizumab in combination with metronomic oral cyclophosphamide: An effective and well-tolerated treatment for patients with recurrent ovarian cancer

Purpose of Investigation: In this study the authors describe their clinical experience with metronomic oral cyclophosphamide and bevacizumab in terms of efficacy and tolerability in patients with recurrent ovarian cancer beyond first-line treatment. Materials and Methods: This retrospective, descriptive study included 59 patients with recurrent ovarian cancer. They were treated with intravenous bevacizumab (10 mg/kg, once every three weeks) in combination with oral cyclophosphamide (100 mg once daily). Patients had received at least one line of platinum-based chemotherapy prior to combined bevacizumab and cyclophosphamide treatment. Both platinum sensitive patients and platinum resistant patients were included. Results: Treatment with combined bevacizumab and cyclophosphamide was administered as a third line therapy in 42.4% of patients. The median number of cycles of bevacizumab administered with oral cyclophosphamide was 7 (range 1-40). A response was demonstrated in 37 (62.7%) patients, with a median progression free survival of 6 months (range 0-44). No toxicity was recorded in the medical report of 39% of patients, with only mild toxicities reported in the others. Conclusion: Bevacizumab combined with metronomic cyclophosphamide appears to be a well-tolerated and effective therapy with sustainable remissions in this selective group heavily pretreated ovarian cancer patients. This regimen should be considered in patients who are not suitable or have no need for more toxic systemic treatment.