Women who have a very poor (≥ 2) performance status or who are symptomatic may not be suitable for the bevacizumab-enhanced therapy, as they may not be able to tolerate the toxicities associated with this regimen.
Notable toxicities reported with the regimen in the GOG 240 study included gastrointestinal fistula and perforation, neutropenia, including febrile neutropenia, hypertension, thrombosis and an increased risk for bleeding in the GI tract.
Understandably, care needs to be taken when considering this regimen for women who may have residual toxicity from other treatments, such as enteritis or cystitis caused by radiotherapy, and those with bowel, bladder, or vaginal involvement.
Women with vaginal bleeding or renal impairment may also not be able to tolerate combined antiangiogenic and chemotherapeutic treatment very well, and women with uncontrolled hypertension might not be good candidates.
Perhaps some of these women could still receive platinum-based chemotherapy without the bevacizumab, but, unfortunately, there will still be women for whom best supportive or palliative care may be the only option, Dr. Ray-Coquard said.
Dr. Ray-Coquard has served on advisory boards convened by Roche and AstraZeneca.