Retrospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jun 27, 2023; 15(6): 1149-1158
Published online Jun 27, 2023. doi: 10.4240/wjgs.v15.i6.1149
Treatment outcome analysis of bevacizumab combined with cyclophosphamide and oxaliplatin in advanced pseudomyxoma peritonei
Ying Zhang, Xin Zhao, Chao Gao, Lin-Yu Lin, Yan Li
Ying Zhang, Xin Zhao, Chao Gao, Lin-Yu Lin, Yan Li, Department of Peritoneal Cancer Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
Author contributions: Zhao X and Gao C collected the data; Zhang Y and Lin LY performed the data analysis; Zhang Y wrote the original draft preparation; Zhang Y and Li Y wrote the review and editing; Li Y contributed to the supervision.
Supported by Beijing Municipal Administration of Hospitals’ Ascent Plan, No. DFL20180701; and Beijing Municipal Grant for Medical Talents Group on Peritoneal Surface Oncology, No. 2017400003235J007.
Institutional review board statement: This study was reviewed and approved by the ethics committee of Beijing Shijitan Hospital, Capital Medical University, No. sjtkyll-lx-2022(066).
Informed consent statement: All study participants or their legal guardian provided written informed consent prior to study enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: We have no data to share.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yan Li, MD, PhD, Doctor, Surgical Oncologist, Department of Peritoneal Cancer Surgery, Beijing Shijitan Hospital, Capital Medical University, No. 10 Tieyi Road, Yangfangdian Street, Haidian District, Beijing 100038, China. liyansd2@mail.ccmu.edu.cn
Received: March 8, 2023
Peer-review started: March 8, 2023
First decision: March 15, 2023
Revised: March 18, 2023
Accepted: April 14, 2023
Article in press: April 14, 2023
Published online: June 27, 2023
Processing time: 99 Days and 8.4 Hours
Abstract
BACKGROUND

Pseudomyxoma peritonei (PMP) is a rare peritoneal malignant tumor syndrome. Cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy is its standard treatment. However, there are few studies and insufficient evidence regarding systemic chemotherapy of advanced PMP. Regimens for colorectal cancer are often used clinically, but there is no uniform standard for late-stage treatment.

AIM

To determine if bevacizumab combined with cyclophosphamide and oxaliplatin (Bev+CTX+OXA) is effective for treatment of advanced PMP. The primary study endpoint was progression-free survival (PFS).

METHODS

Retrospective analysis was conducted on the clinical data of patients with advanced PMP who received Bev+CTX+OXA regimen (bevacizumab 7.5 mg/kg ivgtt d1, oxaliplatin 130 mg/m2 ivgtt d1 and cyclophosphamide 500 mg/m2 ivgtt d1, q3w) in our center from December 2015 to December 2020. Objective response rate (ORR), disease control rate (DCR) and incidence of adverse events were evaluated. PFS was followed up. Kaplan-Meier method was used to draw survival curve, and log-rank test was used for comparison between groups. Multivariate Cox proportional hazards regression model was used to analyze the independent influencing factors of PFS.

RESULTS

A total of 32 patients were enrolled. After 2 cycles, the ORR and DCR were 3.1% and 93.7%, respectively. The median follow-up time was 7.5 mo. During the follow-up period, 14 patients (43.8%) had disease progression, and the median PFS was 8.9 mo. Stratified analysis showed that the PFS of patients with a preoperative increase in CA125 (8.9 vs 2.1, P = 0.022) and a completeness of cytoreduction score of 2-3 (8.9 vs 5.0, P = 0.043) was significantly longer than that of the control group. Multivariate analysis showed that a preoperative increase in CA125 was an independent prognostic factor for PFS (HR = 0.245, 95%CI: 0.066-0.904, P = 0.035).

CONCLUSION

Our retrospective assessment confirmed that the Bev+CTX+OXA regimen is effective in second- or posterior-line treatment of advanced PMP and that adverse reactions can be tolerated. A preoperative increase in CA125 is an independent prognostic factor of PFS.

Keywords: Pseudomyxoma peritonei; Bevacizumab; Oxaliplatin; Cyclophosphamide

Core Tip: For systemic chemotherapy of advanced pseudomyxoma peritonei (PMP), there are currently few studies and insufficient evidence. In this study, the bevacizumab combined with cyclophosphamide and oxaliplatin regimen was used for advanced PMP for the first time. The scheme used in this study was based on clinical experience and had achieved good results.