Bevacizumab is a targeted therapy used to treat ovarian cancer. It is often used in combination with chemotherapy to manage the disease. Its aim is to interfere with processes cancer cells need to grow and spread.
Understanding How Bevacizumab Works
Cancer cells require nutrients and oxygen to grow and multiply, which they obtain by forming new blood vessels. This process, known as angiogenesis, is stimulated by vascular endothelial growth factor (VEGF), often produced by tumor cells. Bevacizumab, a monoclonal antibody, targets and binds to VEGF-A.
By binding to VEGF-A, bevacizumab prevents it from attaching to its receptors on endothelial cells, which line blood vessels. This blocks signals that promote new blood vessel formation. Neutralizing VEGF can shrink or kill existing tumor blood vessels, effectively cutting off the tumor’s blood supply. This “starvation” can slow or stop tumor growth and may also help chemotherapy drugs reach the tumor more effectively by reducing pressure within the tumor’s blood vessels.
When Bevacizumab is Used in Ovarian Cancer Treatment
Bevacizumab is used in several scenarios for ovarian, fallopian tube, or primary peritoneal cancer. It is commonly incorporated into treatment plans for newly diagnosed advanced ovarian cancer. It is typically given alongside chemotherapy after initial surgery, followed by bevacizumab alone as maintenance therapy. This approach has been shown to extend the time patients live without the cancer progressing.
It is also used for recurrent ovarian cancer, both platinum-sensitive and platinum-resistant. For platinum-sensitive recurrent disease, bevacizumab can be combined with chemotherapy regimens such as carboplatin and paclitaxel or carboplatin and gemcitabine, followed by single-agent bevacizumab. In platinum-resistant recurrent ovarian cancer, it may be used with non-platinum chemotherapy drugs like paclitaxel, pegylated liposomal doxorubicin, or topotecan. Starting bevacizumab earlier in recurrence, specifically after the first or second recurrence, can improve overall survival.
Bevacizumab is also approved as a maintenance therapy for patients who have responded well to initial chemotherapy. It can be used as a standalone maintenance therapy or, in certain situations, combined with other targeted therapies like PARP inhibitors, especially for patients whose tumors have specific genetic markers such as BRCA mutations or homologous recombination deficiency (HRD) positive status. Maintenance therapy typically spans around 15 months, though some trials have explored longer durations. Decisions regarding its use are individualized, taking into account the patient’s specific cancer characteristics and prior treatments.
What to Expect During Bevacizumab Treatment
Bevacizumab is administered via intravenous infusion. It is typically given every three weeks. The total number of cycles can vary, with some regimens involving bevacizumab for up to 22 cycles, especially in the first-line setting after initial surgery. Patients may receive bevacizumab for a set duration or continue treatment until the disease progresses or side effects become unmanageable.
Patients undergoing bevacizumab treatment may experience various side effects. Frequently reported side effects include high blood pressure, protein in the urine, fatigue, headache, and nosebleeds. Other common effects can include low red blood cell counts, stomach pain, joint pain, and diarrhea. Your healthcare team will monitor your blood pressure regularly and perform blood tests every three weeks to check for changes in blood cell counts and kidney function.
Some side effects can be more serious, though less common. These include a risk of gastrointestinal perforation, which is a hole developing in the stomach or intestine, and can present with symptoms like severe abdominal pain, nausea, or fever. Bleeding, including serious bleeding in the stomach, brain, or spinal cord, is another potential concern, as is the risk of blood clots. Bevacizumab can also impair wound healing, so it is generally not used for a period before or after surgery until wounds are fully healed. It is important to communicate any new or worsening symptoms to your healthcare team promptly, as early intervention can help manage side effects effectively.