Background: There is a strong rationale for usage of anti-angiogenic agents in epithelial ovarian cancer. Bevacizumab is the
most widely investigated anti-VEGF agent and has shown promising results in recent clinical trials.
Objective: To review the rationale and usage of bevacizumab in advanced epithelial ovarian cancer; as mono-therapy, in combination
with chemotherapy both as first line and for recurrent ovarian cancer as well as in combination with other targeted therapies.
Results: In epithelial ovarian cancer, angiogenesis promotes tumor growth, ascites formation and metastasis. Targeting VEGF in ovarian
cancer patients may have indirect and direct cytotoxic effects.
Results of placebo controlled phase III trials, the GOG-218 and ICON7, of carboplatin-paclitaxel alone or combined with bevacizumab in
chemo-naive patients and the OCEAN trial comparing carboplatin-gemcitabine with or without bevacizumab in women with recurrent
platinum-sensitive epithelial ovarian cancer all suggest a benefit for the addition of bevacizumab on progression free survival. Additionally,
bevacizumab in combination with other targeted therapies, such as sorafenib and everolimus are under investigation in phase II trials
and the current knowledge of molecular predictors is discussed.
In Conclusion: Until now no survival benefit has been observed, but bevacizumab is the first anti-angiogenic agent demonstrating a progression
free survival benefit in addition to standard chemotherapy regimens in advanced epithelial ovarian cancer, both in the upfront
and recurrent setting. Mature overall survival data and the search for predictive biomarkers are important for the future role of bevacizumab
in epithelial ovarian cancer.