Bevacizumab in combination with first-line chemotherapy may result in better clinical outcomes in patients with epithelial ovarian cancer and elevated neutrophil-to-lymphocyte ratios; however, this combination treatment regimen was not found to be advantageous in patients with a high systemic immune inflammation index, according to a study published in Targeted Oncology.

A team of investigators from Italy conducted a multicenter, retrospective analysis to determine the impact of inflammatory responses in patients with International Federation of Gynecology and Obstetrics (FIGO) stage III to IV epithelial ovarian cancer undergoing first-line chemotherapy with or without bevacizumab.

The investigators invited 375 patients to receive either chemotherapy without additional treatment (n=301) or chemotherapy with bevacizumab (n=74). Prior to treatment, patient neutrophil-to-lymphocyte ratios, platelet-to-lymphocyte ratios, and systemic immune inflammation indexes were recorded in order to compare with progression-free survival and overall survival rates.

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Results suggested that patients with a low systemic immune inflammatory index had significantly longer progression-free and overall survival rates. Neutrophil-to-lymphocyte ratios and platelet-to-lymphocyte ratios were significantly correlated with overall survival and progression-free survival, respectively.

Systemic immune inflammation index was strongly affiliated with patient prognosis in patients receiving only chemotherapy without bevacizumab. Patients with elevated neutrophil-to-lymphocyte ratios who received bevacizumab had greater progression-free and overall survival vs patients receiving only chemotherapy; however, patients with a high systemic immune inflammation index had significantly reduced rates of both progression-free and overall survival.

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“Our results suggest that bevacizumab improves clinical outcome in patients with a high [neutrophil-to-lymphocyte ratio] but may be detrimental in those with a high [systemic immune inflammation index],” the authors concluded.


Farolfi A, Petrone M, Scarpi E, et al. Inflammatory indexes as prognostic and predictive factors in ovarian cancer treated with chemotherapy alone or together with bevacizumab: a multicenter, retrospective analysis by the MITO Group (MITO 24) [published online June 14, 2018]. Targ Oncol.