Malignant ascites is debilitating for patients with advanced cancer which negatively impacts the quality of life (Qol). The therapeutic options are limited and often the goal of treatment is to target palliation of symptoms. Increased Vascular Endothelial Growth Factor might be a major cause of the formation of malignant ascites. Intraperitoneal low dose 100mg Bev could be an economical option for symptom control of refractory malignant ascites and to make cost effectiveness as compared to 400mg in other clinical studies. Aims: To analyze clinical efficacy of Intraperitoneal Bevazumab in Patients with advanced cancer and refractory malignant ascites treated at HCG, Bangalore, from july-2014 to Jan-2016.
Patients with advanced cancer and refractory malignant ascites who had received paracentesis at least once within the past 2 weeks were subjected to intraperitoneal Bevacizumab 100mg in 100 ml NaCl 0.9%) after paracentesis. During the 2 months treatment period, a minimum interval of 14d was kept between the applications of Bevazumab. The paracentesis-free survival (ParFS), best response (BR) defined as the longest paracentesis-free period and QoL were analyzed.
29 Patients (median age 57yr), male: Female ratio 0.93:1 received at least one dose application of the Bevazumab and qualified for the intention to treat analysis. The most common underlying malignancy with Ascites were Ovary 34.48%, Stomach 31%. The types of ascetic fluid were Hemorrhagic 55.17%, straw /clear 24.13% and Chylous 20.68%. The median ParFS was 15 days (10-23d) and The BR was 20d (10-60). The median ParFS in patients with hemorrhagic fluid was 20d, straw/clear-14d, chylous 10d and median BR in patients with hemorrhagic fluid was 26d, starw/clear-19d, chylous 14 d. The median ParFS in patients with carcinoma ovary was 17d, & ca stomach 11d, and median BR in patients with ca ovary was 23d, & ca stomach 15d.
Low dose intraperitoneal Bevazumab is an ecomical option and gives better symptom control of malignant ascites especially in hemorrhagic type. Further randomized studies should be conducted and compared between 100mg and 400mg bevazumab before routine clinical practice.
Clinical trial identification
Legal entity responsible for the study
HCG, Ethical Committee
All authors have declared no conflicts of interest.