Survival outcomes of low-dose and high-dose bevacizumab front-line maintenance in advanced high-grade serous ovarian cancer: a propensity score-matched real-world study
Year: 2026
Type: article
Study design: Observational Study
Abstract: Background The optimal dose of bevacizumab for first-line maintenance therapy in advanced ovarian high-grade serous carcinoma (HGSC) remains controversial due to the lack of head-to-head RCTs. This real-world study aimed to compare the efficacy and safety of low-dose (7.5 mg/kg every 3 weeks) and high-dose (15 mg/kg every 3 weeks) bevacizumab in this population. Methods We retrospectively analyzed patients with FIGO stage III–IV HGSC who received first-line bevacizumab maintenance therapy between January 2018 and May 2025. To control for confounding, 1:1 propensity score matching (PSM) was performed with sensitivity analyzes varying matching variables and caliper widths. Inverse probability of treatment weighting (IPTW) was used to confirm robustness. Post-hoc power analysis was performed The primary endpoint was progression-free survival (PFS); secondary endpoints were overall survival (OS) and safety. Results Of 964 screened, 323 were eligible (low dose 179, high dose 144); after 1:1 PSM, 258 patients were matched (129/129) with standardized differences <0.1.After matching, PFS (HR 1.11, 95% CI 0.85–1.43, P = 0.450) and OS (HR 1.07, 95% CI 0.76–1.50, P = 0.688) did not differ significantly. IPTW analysis confirmed these findings (PFS: HR 1.06, P = 0.608; OS: HR 0.99, P = 0.942). Post-hoc power was 12% for the observed PFS HR of 1.11; the minimum detectable HR was 1.45 at 80% power. Prognostic analysis identified FIGO IV, non-complete resection (non-R0) residual disease, presence of ascites, BRCA-negative/unknown status, pre-maintenance CA125 ≥35 U/mL, and neoadjuvant chemotherapy followed by interval debulking surgery (NACT-IDS) as independent adverse factors; bevacizumab dose was not prognostic. Safety was comparable; proteinuria trended lower with low dose (6.98% vs 12.40%, P = 0.147), hypertension was similar, and no gastrointestinal perforations or treatment-related deaths occurred. Sensitivity analyzes were consistent. Conclusions In patients with advanced ovarian HGSC, low-dose and high-dose bevacizumab first line maintenance showed no statistically significant difference in PFS or OS, with a favorable safety signal for the low dose regimen. However, the study was underpowered to confirm equivalence, and a clinically meaningful increase in progression risk cannot be excluded. These findings support the feasibility of low-dose bevacizumab as a first-line maintenance option, pending prospective validation.
Source: Frontiers in Oncology
Language: English
Subfield: Reproductive Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,801
OpenAlex ID: W7166884985