Aim: To retrospectively assess the efficacy and safety of bevacizumab plus low-dose metronomic oral cyclophosphamide
in heavily pretreated patients with recurrent ovarian cancer. Patients and Methods: Patients with recurrent ovarian
cancer and prior treatment with platinum- and taxanebased chemotherapy were included. Treatment consisted of
bevacizumab 10 mg/kg intravenously every 2 weeks plus oral cyclophosphamide 50 mg daily until disease progression
or unacceptable toxicity. Response rates (RR) were determined according to RECIST criteria and by monitoring the
CA 125 serum tumor marker according to Rustin’s criteria.The endpoints were progression-free survival (PFS), RR, overall
survival (OS), and safety. Results: Thirty-eight patients were treated; 79% were platinum resistant and 21% were
platinum sensitive. The median number of previous treatments was 4 (range 1–8). Seventy-nine percent of patients
had received more than 2 previous lines of treatment. Eightyone percent of patients had received gemcitabine, 76% liposomal
doxorubicin, and 50% topotecan. A median of 8 (range 1–70) cycles of bevacizumab were administered. The overall
RR was a complete response (CR) in 3 patients (8.1%), a partial response (PR) in 12 (32.4%), and stable disease (SD) 6 6
months in 3 (8.1%). The median PFS and OS were 4.5 and 10.7 months, respectively. Thirty-nine percent of patients were
progression free for at least 6 months. In an exploratory analysis there was a significant relation of prior platinum response
and performance status with the risk of progression.Grade 3–4 toxicities included anemia (1), hypertension (2),
hematuria (1), arterial thrombosis in the leg (1), dyspnea (1), and intestinal fistulae (1). There were no cases of gastrointestinal
perforation (GIP) or treatment-related deaths. Conclusion: The combination of bevacizumab and metronomic cyclophosphamide
was active and well-tolerated in heavily pretreated patients with recurrent ovarian cancer.
