Addition of bevacizumab to adjuvant chemotherapy paclitaxel and carboplatin for cancer ovary. is there a difference?

Ovarian cancer is considered the 4th most common cause of cancer-related deaths in women, with an about 200.000 new cases and 125.000 deaths occurring yearly all over the world. Symptoms diagnosing the disease are non-specific, including abdominal discomfort or fullness, dyspepsia and bloating, which may be similar to other conditions thus resulting in a delay in diagnosis.1 About 90% of all ovarian cancers are epithelial ovarian cancer (EOC) and arising from the ovarian surface epithelium or mullerian derivatives.2 EOC is highly curable when it is confined to the ovaries, with expected 5-year survival up to 90%. However, it is rarely diagnosed at an early stage because the disease causes few specific symptoms when it is localized to the ovary. More than 70% with EOC present with advanced stage III or IV, which is associated with high morbidity and mortality.3 Current management of advanced disease includes surgical tumor debulking, followed by adjuvant platinum-and taxane-based chemother apy.4 An approach to improve the outcome of treatment in EOC has focused on modifying the dose, sched ule and route of administration of chemotherapy. The use of intra-peritoneal chemotherapy has been reported to improve outcomes although, an increase in the toxicity.5 Recently, the administration of intravenous (IV) pacli taxel on a weekly schedule improves PFS and OS.6 Another recently approach is the administration of chemotherapy in the neoadjuvant setting, before surgical resection in contrast to conven tional postoperative chemotherapy. Although it is associated with optimal cytoreduction and lower postoperative adverse events, it did not improve OS.7 Therefore, the combination of carboplatin and paclitaxel remains the standard chemo therapy regimen in advanced ovarian cancer, however, OS for patients with advanced disease is poor and the 5-year survival is only 27%.8 Also, the majority of women with advanced stages recur within 5 years with emerging a drug resistance.3 Angiogenesis was found contributing to solid-tumor growth and metastasis.9 EOC cell lines were found frequently expressing the VEGF.10 In literatures, high serum VEGF levels correlated with a higher risk of death or recurrence in ovarian cancer.11 Also, it has been implicated in the peritoneal dissemination and development of malignant ascites12 which is inversely linked with survival.13,14