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Primary ovarian cancer: possibilities for improving treatment outcomes

Ovarian cancer is the fifth leading cause of cancer-related death among women in the world. In spite of recent progress in treatment strategy, around 70 % of ovarian cancer patients relapse. The cytoreductive surgery followed by platinum-, taxane-containing chemotherapy is the standard approach to the primary treatment of ovarian cancer; a variant of neoadjuvant chemotherapy with interval cytoreduction may be used in patients with stage IIIC-IV disease. Given that angiogenesis plays a central role in progression of solid tumour growth and metastasis, recent studies have focused on anti-angiogenic treatment. Bevacizumab, a humanized IgG monoclonal antibody that inhibits the vascular endothelial growth factor receptor, is most promising antiangiogenic drug. Bevacizumab was approved on December 23, 2011 by the European Medicines Agency and on June 13, 2018 by the Food and Drug Administration as first-line treatment in epithelial ovarian, fallopian tube or primary peritoneal cancer stage III or IV in combination with carboplatin and paclitaxel. Based on sub-analyses, the recommended dosage of bevacizumab is 15 mg/kg every 3 weeks for a total of 22 cycles. Bevacizumab is a well-studied drug with a favourable safety profile that has been used in routine clinical practice for more than 10 years. However, the search for predictors to identify the category of patients, who will benefit most from bevacizumab therapy, is still in progress, and clinical trials that may improve the therapeutic potential in treating ovarian cancer in the near future due to introduction of new combinations of bevacizumab with PARP inhibitors and immuno-oncological drugs are under way. In view of acquisition of mature clinical trial data, a range of the most discussed issues regarding optimal use of bevacizumab in patients with ovarian cancer has been identified.