Bevacizumab in Advanced High Grade Serous Ovarian Cancer: The Impact of BRCA Mutation Status

Introduction: BRCA mutation status plays a pivotal role in determining sensitivity to PARP inhibitors. however, its influence on the clinical benefit derived from Bevacizumab remains less clearly established. This study aims to assess survival outcomes of Bevacizumab in advanced high-grade serous ovarian cancer (HGSOC) based on BRCA mutation status. Methods: The study included 101 patients with advanced HGSOC who were diagnosed and treated at Tanta University Hospital. All patients were tested for BRCA1/2 mutations. Patients received six cycles of weekly carboplatin and paclitaxel, with or without Bevacizumab, followed by maintenance Bevacizumab. Patients were categorized into two groups based on whether they received Bevacizumab or not, and were further stratified according to BRCA mutation status. Results: Bevacizumab significantly improved progression-free survival (PFS) among patients with BRCA wild-type tumors (median PFS was 24.0 months versus 18.0 months, HR (95% CI: 0.1764 (0.07581 to 0.4103), P = 0.012). BRCA-mutated patients did not show a significant PFS advantage (median PFS 23 vs. 20 months, P = 0.111). OS did not differ significantly with the use of Bevacizumab, either in the BRCA wild-type or mutated group. Univariate analysis identified FIGO stage and residual tumor (RT) as significant predictors of PFS. In the multivariate model, only the residual tumor remained significant. For OS, the FIGO stage was the sole significant factor. Conclusion: Bevacizumab added a significant PFS advantage in BRCA wild-type patients, while patients with BRCA mutations did not achieve the same benefit, suggesting that Bevacizumab may be prioritized for BRCA wild-type patients.