贝伐单抗联合化疗优于单纯化疗在PARPi治疗后复发的卵巢癌中的多中心倾向评分匹配分析证据

Bevacizumab combined with chemotherapy could be superior to chemotherapy alone in relapsed ovarian cancer after PARPi: evidence from a multi-center propensity score-matched analysis

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Journal of Gynecologic Oncology

影响因子:3.7

分区:医学2区 / 妇产科学3区肿瘤学3区

发表日期:2025 May

作者: Lin Zhong, Haixia Wang, Cuirong Lei, Dongling Zou

DOI: 10.3802/jgo.2025.36.e36

摘要

本研究采用回顾性多中心倾向评分匹配（PMS）分析，探讨贝伐单抗联合化疗在曾接受多腺苷二磷酸核糖聚合酶（PARPi）治疗后复发的上皮性卵巢癌（EOC）患者中的疗效与安全性。共纳入来自4家医疗中心的250例PARPi治疗后复发的卵巢癌患者，比较两组的无进展生存期（PFS）。多变量分析显示，加入贝伐单抗的化疗显著延长PFS（风险比[HR]=0.49；95%置信区间[CI]=0.34-0.72；p<0.001）。经过倾向评分匹配后，选取了55例接受贝伐单抗联合化疗的患者（A组）和55例接受化疗单一方案的患者（B组）。两组的PFS差异具有统计学意义（HR=0.62；95% CI=0.40-0.97；p=0.036），提示联合方案具有更优的临床效果。中位PFS在A组为11个月，在B组为9个月。无残存肿瘤（RCRS）和铂类耐药亚组的患者中，PFS差异更为明显（HR=0.50；95% CI=0.30-0.82，以及HR=0.31；95% CI=0.14-0.68）。A组中3-4级不良反应更常见，且出现严重高血压和肠穿孔的病例仅在A组中报告。综上所述，PARPi复发后，贝伐单抗联合化疗方案与单一化疗相比，具有更好的PFS。

Abstract

A retrospective, multi-center propensity score-matched (PMS) analysis was conducted to investigate the efficacy and safety of the treatment strategy that combines bevacizumab and chemotherapy for patients with relapsed epithelial ovarian cancer (EOC) who previously received poly ADP-ribose polymerase inhibitors (PARPis).A total of 250 ovarian cancer (OC) patients relapsed after PARPi received chemotherapy with or without bevacizumab at 4 medical centers were enrolled in the study. For both treatments, Kaplan-Meier analysis and Cox regression were used to compare PFS.In the multivariable analysis of 250 patients, the incorporation of bevacizumab into chemotherapy demonstrated a significant enhancement in PFS (hazard ratio [HR]=0.49; 95% confidence interval [CI]=0.34-0.72; p<0.001). Fifty-five patients were enrolled in Group A (bevacizumab combined with chemotherapy) and 55 were enrolled in Group B (chemotherapy alone regime) after PSM analysis. A statistically significant difference in PFS was observed between the 2 regimens (HR=0.62; 95% CI=0.40-0.97; p=0.036), suggesting that the bevacizumab combined with chemotherapy regimen confers superior clinical benefits. The median PFS was 11 months in Group A and 9 months in Group B. A significant variation was noted in PFS between patients without RCRS (HR=0.50; 95% CI=0.30-0.82) and the platinum-resistant subgroup (HR=0.31; 95% CI=0.14-0.68). Adverse effects of Grade 3-4 were more prevalent in Group A than in Group B. Additionally, instances of severe hypertension and bowel perforation were reported solely within Group A.In patients diagnosed with EOC relapsed after PARPi, the regime of chemotherapy combined with bevacizumab is associated with better PFS.