癌思停合併化療用在27位復發性卵巢癌和腹膜癌病人：一家台灣醫學中心經驗

Bevacizumab Combination with Chemotherapy for Recurrent Ovarian and Peritoneal Cancer: 27 Patients in One Taiwan Medical Center Experience

癌思停 Bevacizumab (Avastin®; Genentech, South San Francisco, CA, USA) 是一種對抗血管內皮新生因子(anti-VEGF)的重組單株抗體，目前已准許使用在合併carboplatin 和 paclitaxel化學治療的晚期卵巢上皮癌、輸卵管癌和原發性腹膜癌;同時抗血管新生藥物與carboplatin和gemcitabine合併可用於治療復發性platinum-sensitive卵巢癌一直是目前在研發中、或者有潛力研發用來治療復發性卵巢癌的標靶藥物治療。 雖然目前已有第三期臨床試驗使用Bevacizumab 治療復發性的卵巢上皮癌和原發性腹膜癌的第一線治療經驗，然而，後線使用Bevacizumab治療經驗較少被發表。我們提出27個病人後線使用Bevacizumab的效度及副作用經驗，我們的資料顯示48%的反應率及平均4個月的無疾病存活時間和平均8個月總存活期；最常見的血液方面的副作用包含21%的第三或第四級中性球低下及7%的第三或第四級血小板低下，然而，7%的腸胃道穿孔為使用Bevacizumab最令人在意的副作用，高於目前使用在第一線的Bevacizumab有2%的副作用。這些資訊可以給台灣的臨床婦癌科醫師另一方面的參考及臨床運用。

Bevacizumab is a recombinant monoclonal antibody against vascular endothelial growth factor, and it is approval in combination with carboplatin and paclitaxel for the frontline treatment of advanced epithelial ovarian cancer, fallopian tube cancer and primary peritoneal cancer, as well as for the treatment of the first recurrence of platinum-sensitive ovarian cancer in combination with carboplatin and gemcitabine. As angiogenesis is related to the progression of ovarian cancer, a number of anti-angiogenic agents have been proposed or are currently in development as potential treatment options for patients with advanced disease. Currently available data come from randomized, controlled studies enrolling women with primary or recurrent ovarian cancer receiving frontline treatment with bevacizumab and different regimens of chemotherapy. However, the experience of chemotherapy with bevacizumab in late-line treatment in patients with recurrent ovarian cancer has rarely been reported. In this study, we present the efficacy and adverse effects in 27 patients who received a total of 106 cycles of bevacizumab as combination chemotherapy for the late-line treatment of recurrent ovarian and peritoneal cancer. Our results revealed a 48% response rate, a median progression-free survival of 4 months, and a median overall survival of 8 months. The most common adverse effects of hematological toxicity were 21% grade 3 or 4 neutropenia and 7% grade 3 or 4 thrombocytopenia. However, the most serious adverse effects were gastrointestinal perforations in 2 of the 27 patients (7%), which is higher than <2% reported in those receiving frontline treatment in clinical trials. Our findings may provide data to guide the clinical use of bevacizumab in Taiwan.