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A CASE SERIES OF BEVACIZUMAB IN COMPLEX THERAPY IN PATIENTS WITH ADVANCED SEROUS EPITHELIAL OVARIAN CANCER IN BELARUS
This document presents a case series evaluating the safety and efficacy of bevacizumab in combination with standard chemotherapy for patients with advanced serous epithelial ovarian cancer in Belarus. The results indicate that the treatment was well tolerated and showed activity, with varying degrees of response among patients. The study aims to establish the optimal regimen for bevacizumab in this context.
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A CASE SERIES OF BEVACIZUMAB IN COMPLEX THERAPY IN PATIENTS WITH ADVANCED SEROUS EPITHELIAL OVARIAN CANCER IN BELARUS
- 1. A CASE SERIESOF BEVACIZUMAB IN COMPLEX THERAPY IN PATIENTS WITH ADVANCED SEROUS EPITHELIAL OVARIAN CANCER IN BELARUS graduate student, Department of Oncology H. Anishchanka supervisor: associate professor, Department of Oncology, MD S. Shelkovich Belarusian Medical Academy of Postgraduate Education Minsk 2013
- 2. Ovarian cancer remainsa pressing problem in oncology and the leading cause of death from gynecologic malignancy.
- 3. Incidence in Belarus 15,4 16,2 18,1 16,6 18,3 19,4 14 16 18 20 20012005 2010 Belarus Minsk
- 4. •The main rolein the treatment of ovarian carcinoma belongs to surgery and chemotherapy.
- 5. Mortality According to thecumulative population- based cancer registries in Europe one-year survival rate of patients with ovarian cancer is 63% three-year- 41% five-year- 35%
- 6. 703 new casesof ovarian cancer were revealed in Minsk since 2006 to 2010 histological cytological verification verification 624 (89%) 79 (11%) serous epithelial ovarian cancer 456 (73%)
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- 9. Relapse after completedebulking 33% advanced cancer N=107
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- 14. A lot ofnovel drugs have appeared for the treatment of ovarian cancer, including target drugs. The most perspective group is antiangiogenic drugs.
- 15. The most studiedantiangiogenic drug is bevacizumab (Avastin) – a recombinant humanised monoclonal antibody that targets VEGF. Bevacizumab inhibits binding of VEGF to its receptors on the surface of endothelial cells, thus decreasing tumor vascularity and growth.
- 16. AIM to assess thesafety and activity of bevacizumab in the first-line treatment of advanced serous epithelial ovarian cancer
- 17. Характеристики Количество больных Возраст (лет): ≤45 >45 средний 3(50 %) 3 (50%) 56,6 ± 12 Распространение опухоли (FIGO): IIС (T2CN0M0) IIIС (T3CN0M0) IIIС (T3CN1M0) 2 (33,3%) 2 (33,3%) 2 (33,3%) Степень дифференцировки: G1 G2 G3 G4 1 (17%) 1 (17%) 2 (33,3%) 2 (33,3%) PATIENTS FEATURES PATIENTS Age (years): ≤45 >45 average 3 (33 %) 6 (77%) 56,6 ± 12 FIGO : IIС (T2CN0M0) IIIС (T2CN1M0) IIIС (T3CN0M0) IIIС (T3CN1M0) 1 (11,1%) 1 (11,1%) 5 (55,6%) 2 (22,2%) Differentiation: G1 G2 G3 G4 2 (22,2%) 1 (11,1%) 4 (44,5%) 2 (22,2%)
- 18. DEBULKING optimal suboptimal >2sm 33,3% (3) 11,1% (1) 55,6% (5)
- 19. CHEMOTHERAPYCHEMOTHERAPY 1cycle – paclitaxel(175 mg/м2 ) + carboplatin (AUC 5-6) 2cycle - paclitaxel (175 mg/м2 ) + carboplatin (AUC 5-6) + bevacizumab (7,5 мg/kg) 3cycle - paclitaxel (175 mg/м2 ) + carboplatin (AUC 5-6) + bevacizumab (7,5 мg/kg) 4cycle - paclitaxel (175 mg/м2 ) + carboplatin (AUC 5-6) + bevacizumab (7,5 мg/kg) 5cycle - paclitaxel (175 mg/м2 ) + carboplatin (AUC 5-6) 6cycle - paclitaxel (175 mg/м2 ) + carboplatin (AUC 5-6)
- 20. ADVERSE REACTIONS : 1.Alopecia 2. Nausea / vomiting 3. Stomatitis 4. Paresthesia 5. Angiostaxis 6. Increased blood pressure
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- 22. Blood pressure Before surgery After surgery 1 cycle CT 2cycle CT 3cycle CT 4cycle CT 5cycle CT 6cycle CT Patient 6 100/70105/70 110/70 140/100 140/90 140/100 110/70 110/75 Patient2 120/80 125/75 120/75 125/80 120/80 115/75 120/70 120/80 Patient 4 145/90 150/80 140/90 180/100 180/100 180/100 140/80 140/75 Patient 1 140/90 145/85 140/80 180/100 180/100 180/100 140/90 140/80 Patient 3 110/70 115/70 115/70 120/70 120/75 115/75 120/80 115/70 Patient 5 130/80 125/80 120/75 120/80 130/75 120/80 120/70 120/75 Blood Pressure
- 23. Hematologic toxicity wasnot revealed.
- 24. Нв, g/l Before surgery After surgery 1cycle CT 2cycl e CT 3cycle CT 4cycle CT 5cycle CT 6cycle CT Patient 6 88 85 104 106 116 127 117 128 Patient2 107 104 112 125 132 112 124 119 Patient 4 111 114 120 130 125 113 125 123 Patient 1 111 104 107 109 103 125 118 119 Patient 3 87 98 112 125 123 135 124 130 Patient 5 130 107 104 104 117 125 103 109 105 102 109 116 119 123 119 121 Hemoglobin
- 25. PLTх109 /l Before surgery After surgery 1 cycle CT 2cycl eCT 3cycle CT 4cycle CT 5cycle CT 6cycle CT Patient 6 321 312 377 232 181 187 259 254 Patient2 415 301 373 285 343 143 124 147 Patient 4 321 121 125 125 182 103 128 194 Patient 1 210 301 199 183 204 205 283 300 Patient 3 340 340 373 285 325 363 126 190 Patient 5 245 165 150 109 142 100 178 308 308 256 232 Platelets
- 26. WBC, х109 /l Before surgery After surgery 1cycle CT 2cycle CT 3cycle CT 4cycle CT 5cycle CT 6cycle CT Patient 6 5,1 5 4,13 2,77 5,35 4,3 2,59 3,62 Patient2 6,4 10,53 6,82 5,14 7,38 5,4 4,5 4,6 Patient 4 6,9 4,1 5,23 8,31 4,92 2,54 4,69 3,29 Patient 1 6,7 10,53 3,8 7,5 2,63 5,6 6,66 5,4 Patient 3 11,7 9,5 6,82 6,82 7,2 7,21 5,1 3,9 Patient 5 4,8 3,5 4,22 3,37 4,74 3,97 4,4 2,63 6,93 7,2 5,17 5,65 5,37 4,84 4,66 3,9 White blood cells
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- 28. СА-125, Е/ml Before surgery After surgery 1cycle CT 2cycle CT 3cycle CT 4cycle CT 5cycle CT 6cycle CT Patient 6 133,4 23,72 5,26 4,36 5,34 6,7 5,76 8,57 Patient2 282 276,1 1,85 1,81 2,17 1,81 2,27 0,73 Patient 4 208,4 80 76,6 23,31 24,2 14,4 10,0 9,82 Patient 1 284,5 276,1 26,5 20,2 10,1 9,8 7,2 4,3 Patient 3 1119 543 354 27,9 26,3 10,2 9,1 5,3 Patient 5 208 70,3 16,4 17,76 13,65 12,1 10,9 4,9 372,6 7,6 СА-125
- 29. The direct effectwas assessed by contrast enhanced CT
- 30. CONTROL outbreaks: localization №cutoff diameter peritoneum 16 19mm porta of hepar 32 52mm The sum of the largest diameter 71mm Lymph nodes Right retroperitoneal lymph node 75 30mm The sum of the diameter 30mm Sum of the diameters of all the control outbreakes 101mm Patient 1 before treatment
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- 34. Patient 1 aftertreatment CONTROL outbreaks: localization № cutoff diameter peritoneum 15 14mm porta of hepar 33 26mm The sum of the largest diameter 40mm Lymph nodes Right retroperitoneal lymph node 73 13mm The sum of the diameter 13mm Sum of the diameters of all the control outbreakes 53mm
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- 38. Patient 3 beforetreatment CONTROL outbreaks: localization № cutoff diameter Peritoneum on the right 76 18mm Peritoneum on the left 71 21mm The sum of the largest diameter 39mm Lymph nodes The sum of the diameter Sum of the diameters of all the control outbreakes 39mm
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- 40. Patient 3 aftertreatment CONTROL outbreaks: localization № cutoff diameter Peritoneum on the right 76 12mm Peritoneum on the left 67 17mm The sum of the largest diameter 29mm Lymph nodes The sum of the diameter Sum of the diameters of all the control outbreakes 29mm
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- 42. Patient 4 beforetreatment CONTROL outbreaks: localization № cutoff diameter The sum of the largest diameter Lymph nodes para-aortic lymph node 58 11 The sum of the diameter Sum of the diameters of all the control outbreakes 11mm
- 44. Patient 4 aftertreatment CONTROL outbreaks: localization № cutoff diameter The sum of the largest diameter Lymph nodes para-aortic lymph node 58 7 The sum of the diameter Sum of the diameters of all the control outbreakes 7mm
- 46. Patient 5 beforetreatment CONTROL outbreaks: localization № cutoff diameter The sum of the largest diameter Lymph nodes Left para-aortic lymph node 65 18 Left para-aortic lymph node 77 19 The sum of the diameter Sum of the diameters of all the control outbreakes 37mm
- 49. Patient 5 aftertreatment CONTROL outbreaks: localization № cutoff diameter The sum of the largest diameter Lymph nodes Left para-aortic lymph node 60 14 Left para-aortic lymph node 67 11 The sum of the diameter Sum of the diameters of all the control outbreakes 25mm
- 52. Stage First debulking СА125 first BP RECIST СА125 finish Second bulkingResponse Patient 6 T2CN0M0 G3 optimal 133,4 140/100 8,57 нет Complete response Patient2 T3CN0M0 G1 optimal 282 125/80 0,73 нет Complete response Patient 4 T2CN1M0 G4 suboptimal 208,4 180/100 9,82 + Complete response Patient 1 T3CN1M0 G3 >2sm 284,5 180/100 101/53 4,3 + Partial response (90% ) Patient 3 T3CN0M0 G2 >2sm 1119 120/70 39/29 5,3 + Partial response (50%) Patient 5 T3CN1M0 G4 >2sm 208 120/80 37/25 4,9 + Complete response
- 53. CONCLUSIONS: • Bevacizumab incombination with standard chemotherapy was well tolerated and active in first-line treatment of advanced serous epithelial ovarian cancer. • Study continues to find out optimal regimen of bevacizumab.