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Multicenter Study
. 2025 Sep;36(5):e80.
doi: 10.3802/jgo.2025.36.e80. Epub 2025 Mar 10.

Bevacizumab in frontline chemotherapy improved the survival outcome for advanced ovarian clear cell carcinoma: a multicenter retrospective analysis

Shinichi Tate #  1 , Toshiyuki Seki #  2 , Kyoko Nishikimi  3 , Youichi Unno  4 , Mizue Itoi  5 , Sadatomo Ikeda  6 , Nobuhisa Yoshikawa  7 , Hidehiko Akashi  8 , Eitaro Suzuki  2 , Naotake Tanaka  5 , Takashi Hirakawa  6 , Hiroaki Kajiyama  7 , Hirokuni Takano  2 , Kosuke Yoshihara  8 , Kaori Koga  3 , Aikou Okamoto  2 , Makio Shozu  3   9
Affiliations
Multicenter Study

Bevacizumab in frontline chemotherapy improved the survival outcome for advanced ovarian clear cell carcinoma: a multicenter retrospective analysis

Shinichi Tate et al. J Gynecol Oncol. 2025 Sep.

Abstract

Objective: Advanced ovarian clear cell carcinoma (OCCC) is associated with poor outcomes owing to chemoresistance. Bevacizumab (Bev) is increasingly being used to treat advanced ovarian cancer; however, its efficacy in OCCC remains unclear. This study evaluated the treatment outcomes of frontline bevacizumab chemotherapy in patients with OCCC.

Methods: This retrospective multi-institutional study included patients diagnosed with advanced OCCC at eight institutions in Japan between 2008 and 2018. Patients were categorized into pre and post-market groups based on the Bev approval dates. Progression-free survival (PFS) and overall survival (OS) were analyzed using univariate and multivariate methods. Additionally, patients were classified into Bev-treated (Bev+) and non-Bev-treated (Bev-) groups, and their prognoses were compared.

Results: A total of 96 patients were in the pre-market group and 82 in the post-market group. The post-market group had a significantly higher proportion of patients with poor performance status and patients who underwent interval debulking surgery (p<0.01 and p<0.01, respectively). Univariate analysis demonstrated a better PFS in the post-market group (p=0.041). In multivariate analysis, better PFS (hazard ratio [HR]=0.52; p=0.002) and OS (HR=0.47; p=0.002) were observed in the post-market group than in the pre-market group. Bev+ patients had significantly better PFS and OS than Bev- patients in univariate (p<0.001 and p<0.001, respectively) and multivariate analyses (PFS: HR=0.36; p<0.001 and OS: HR=0.21; p=0.001, respectively).

Conclusion: Incorporating Bev into frontline chemotherapy may improve outcomes in patients with advanced OCCC.

Keywords: Adenocarcinoma, Clear Cell; Bevacizumab; Ovarian Neoplasms.

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Conflict of interest statement

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1
Fig. 1. Patients’ cohort.
Bev+, bevacizumab-treated; Bev−, non-bevacizumab-treated; TC, paclitaxel and carboplatin. *The reasons of no addition of bevacizumab: patient’s desire (n=2), clinical trial (n=2), doctor’s preference (n=20; thrombosis n=8, dose dense paclitaxel and carboplatin n=8, unknown n=4), unknown (n=15).
Fig. 2
Fig. 2. Survival curves of pre- and post-market period.
(A) PFS and (B) OS. OS, overall survival; PFS, progression-free survival.
Fig. 3
Fig. 3. Survival curves according to bevacizumab use.
(A) PFS and (B) OS. Bev+, bevacizumab-treated; Bev−, non-bevacizumab-treated; OS, overall survival; PFS, progression-free survival.
See this image and copyright information in PMC

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