Efficacy and safety of nab-paclitaxel combined with bevacizumab in the treatment of platinum-resistant recurrent ovarian cancer

doi:10.3760/cma.j.cn371439-20260508-00106

Abstract

Abstract:

Objective To investigate the efficacy and safety of nab-paclitaxel combined with bevacizumab in the treatment of platinum-resistant recurrent ovarian cancer. Methods A total of 71 patients with platinum-resistant recurrent ovarian cancer admitted to Qilu Hospital of Shandong University from June 2022 to June 2025 were enrolled. All patients received ≥3 cycles of nab-paclitaxel combined with bevacizumab. Efficacy and safety were evaluated after treatment. Survival outcomes were estimated using the Kaplan-Meier method and compared via log-rank tests. Results The mean number of treatment cycles of 5.63±1.37. The ORR was 50.70%（36/71）. The DCR was 81.69% （58/71）. The DCR in patients with time interval from last platinum-based chemotherapy to recurrence ≤3 months was significantly lower than that in patients with a time interval of >3 months and ≤6 months [72.97% （27/37） vs. 91.18% （31/34）； χ²=3.93， P=0.048]. After 4 cycles of treatment， patients with a carbohydrate antigen 125 （CA125） decrease of ≥50% had an ORR of 66.67% （30/45） and a DCR of 91.11% （41/45）， both higher than those with a decrease of <50% [26.67% （4/15） and 60.00% （9/15）， respectively； χ²=7.33， P=0.007； χ²=7.84， P=0.005]. Patients without prior bevacizumab treatment had higher ORR [70.37% （19/27）] and DCR [96.3% （26/27）] than those who had previously received bevacizumab [38.64% （17/44） and 72.73% （32/44）， respectively； χ²=6.74， P=0.009； χ²=6.21， P=0.013]. Survival analysis showed that the median progression-free survival （PFS） of the 71 patients was 7.0 months. The median PFS for patients with a time from last platinum-based chemotherapy to recurrence of > 3 months and ≤ 6 months （9.0 months） showed a trend of prolongation compared to those with ≤ 3 months （6.0 months）， but there was no statistically significant difference （χ²=3.82， P=0.051）.The most common adverse events were neurotoxicity [57.75% （41/71）]， proteinuria [46.48% （33/71）]， and nausea/vomiting [46.48% （33/71）]， predominantly grade 1-2. The main grade 3-4 adverse reaction was neutropenia [15.49% （11/71）]. Conclusions Nab-paclitaxel combined with bevacizumab shows promising efficacy and good tolerability in the treatment of platinum-resistant recurrent ovarian cancer.

Key words: Ovarian neoplasms, Recurrence, Albumin-bound paclitaxel, Bevacizumab, Progression-free survival

Zhang Ting, Chen Qian, Qian Qiuhong. Efficacy and safety of nab-paclitaxel combined with bevacizumab in the treatment of platinum-resistant recurrent ovarian cancer[J]. Journal of International Oncology, 2026, 53(11): 681-687.

Figures/Tables 4

References 21

[1]	Siegel RL, Kratzer TB, Wagle NS, et al. Cancer statistics, 2026[J]. CA Cancer J Clin, 2026, 76(1): e70043. DOI: 10.3322/caac.70043.
[2]	Wang Q, Kuang L, Liu B, et al. A real-world retrospective cohort study: the clinical outcomes and characteristics of platinum-resistant recurrent ovarian cancer[J]. Transl Cancer Res, 2025, 14(5): 3161-3174. DOI: 10.21037/tcr-2025-641. pmid: 40530141
[3]	Pujade-Lauraine E, Hilpert F, Weber B, et al. Bevacizumab combined with chemotherapy for platinum-resistant recurrent ovarian cancer: the AURELIA open-label randomized phase Ⅲ trial[J]. J Clin Oncol, 2014, 32(13): 1302-1308. DOI: 10.1200/JCO.2013.51.4489. pmid: 24637997
[4]	Leung JH, Leung HWC, Wang SY, et al. Comparison of target agent treatment strategies for platinum-resistant recurrent ovarian cancer: a Bayesian network meta-analysis[J]. Medicine (Baltimore), 2024, 103(21): e38183. DOI: 10.1097/MD.0000000000038183.
[5]	Burger RA, Sill MW, Monk BJ, et al. Phase Ⅱ trial of bevacizumab in persistent or recurrent epithelial ovarian cancer or primary peritoneal cancer: a Gynecologic Oncology Group study[J]. J Clin Oncol, 2007, 25(33): 5165-5171. DOI: 10.1200/JCO.2007.11.5345.
[6]	Poveda AM, Selle F, Hilpert F, et al. Bevacizumab combined with weekly paclitaxel, pegylated liposomal doxorubicin, or topotecan in platinum-resistant recurrent ovarian cancer: analysis by chemotherapy cohort of the randomized phase Ⅲ AURELIA trial[J]. J Clin Oncol, 2015, 33(32): 3836-3838. DOI: 10.1200/JCO.2015.63.1408.
[7]	Shahin MS, Mathur R, Parthan A, et al. Comparative outcomes of nab-paclitaxel and paclitaxel in platinum-resistant ovarian cancer (COMPASS)[J]. Gynecol Oncol, 2026, 204: 202-209. DOI: 10.1016/j.ygyno.2025.11.022.
[8]	Kase AM, Azzouqa AG, Kochuveettil S, et al. Efficacy of gemcitabine in combination with nanoparticle albumin-bound paclitaxel in the treatment of recurrent ovarian cancer: a retrospective single institution review[J]. Cancer Med, 2023, 12(8): 9434-9438. DOI: 10.1002/cam4.5705.
[9]	Li S, Xian B, Cui L, et al. Safety and efficacy of nab-paclitaxel combined with nedaplatin and bevacizumab in patients with platinum-resistant epithelial ovarian cancer: a retrospective cohort study[J]. J Cancer Res Clin Oncol, 2026, 152(3): 76. DOI: 10.1007/s00432-026-06461-5.
[10]	Olawaiye AB, Gladieff L, O'Malley DM, et al. Relacorilant and nab-paclitaxel in patients with platinum-resistant ovarian cancer (ROSELLA): an open-label, randomised, controlled, phase 3 trial[J]. Lancet, 2025, 405(10496): 2205-2216. DOI: 10.1016/S0140-6736(25)01040-2. pmid: 40473448
[11]	中国抗癌协会妇科肿瘤专业委员会. 卵巢恶性肿瘤诊断与治疗指南(2021年版)[J]. 中国癌症杂志, 2021, 31(6): 490-500. DOI: 10.19401/j.cnki.1007-3639.2021.06.07.
[12]	Trillsch F, Mahner S, Czogalla B, et al. Primary platinum resistance and its prognostic impact in patients with recurrent ovarian cancer: an analysis of three prospective trials from the NOGGO study group[J]. J Gynecol Oncol, 2021, 32(3): e37. DOI: 10.3802/jgo.2021.32.e37. pmid: 33825355
[13]	Shoji T, Enomoto T, Abe M, et al. Efficacy and safety of standard of care with/without bevacizumab for platinum-resistant ovarian/fallopian tube/peritoneal cancer previously treated with bevacizumab: the Japanese Gynecologic Oncology Group study JGOG3023[J]. Cancer Sci, 2022, 113(1): 240-250. DOI: 10.1111/cas.15185.
[14]	Lorusso D, Gladieff L, O'Malley DM, et al. Overall survival with relacorilant and nab-paclitaxel in patients with platinum-resistant ovarian cancer (ROSELLA): a phase 3 randomised controlled trial[J]. Lancet, 2026, 407(10538): 1513-1524. DOI: 10.1016/S0140-6736(26)00462-9.
[15]	Ozberk U, Esen SA, Sekmek S, et al. Survival advantage of bevacizumab rechallenge in recurrent ovarian cancer regardless of platinum sensitivity[J]. Anticancer Drugs, 2026, 37(6): 359-365. DOI: 10.1097/CAD.0000000000001798.
[16]	Rustin GJ, Vergote I, Eisenhauer E, et al. Definitions for response and progression in ovarian cancer clinical trials incorporating RECIST 1.1 and CA125 agreed by the Gynecological Cancer Intergroup (GCIG)[J]. Int J Gynecol Cancer, 2011, 21(2): 419-423. DOI: 10.1097/IGC.0b013e3182070f17.
[17]	Ambrosino FA, Pisano C, Napoli MD, et al. KELIM score: a marker of chemosensitivity in ovarian cancer[J]. Cancer Treat Rev, 2026, 143: 103071. DOI: 10.1016/j.ctrv.2025.103071.
[18]	Nasu H, Nishio S, Park J, et al. Platinum rechallenge treatment using gemcitabine plus carboplatin with or without bevacizumab for platinum-resistant ovarian cancer[J]. Int J Clin Oncol, 2022, 27(4): 790-801. DOI: 10.1007/s10147-021-02103-7. pmid: 34985551
[19]	He F, Liu J, Shen X, et al. Adverse event profile for nanoparticle albumin-bound paclitaxel compared with solvent-based taxanes in solid-organ tumors: a systematic review and meta-analysis of randomized clinical trials[J]. Ann Pharmacother, 2022, 56(8): 898-909. DOI: 10.1177/10600280211058385.
[20]	中华医学会妇科肿瘤学分会, 孔北华, 向阳, 等. 妇科肿瘤抗血管内皮生长因子单克隆抗体临床应用指南(2026版)[J]. 现代妇产科进展, 2026, 35(2): 81-92. DOI: 10.13283/j.cnki.xdfckjz.2026.02.001.
[21]	Storandt MH, Tran NH, Ehret CJ, et al. Gastrointestinal perforation after bevacizumab: a multi-site, single-institution study with a focus on survival[J]. World J Surg Oncol, 2023, 21(1): 177. DOI: 10.1186/s12957-023-03058-x. pmid: 37291587

病理特征	结果	病理特征	结果
绝经		基因检测结果
是	62（87.32）	BRCA（+）	8（11.27）
否	9（12.68）	BRCA（-），HRD（+）	8（11.27）
初诊FIGO分期（期）		HRD（-）	13（18.31）
Ⅰ	2（2.82）	BRCA（-）	15（21.13）
Ⅱ	4（5.63）	未知	27（38.03）
Ⅲ	52（73.24）	复发部位
Ⅳ	13（18.31）	腹腔转移	20（28.17）
病理类型		盆腔转移	16（22.54）
高级别浆液性癌	67（94.37）	远处转移	4（5.63）
黏液性癌	1（1.41）	多部位转移	31（43.66）
子宫内膜样癌	2（2.82）	末次化疗至复发时间（月）
神经内分泌癌	1（1.41）	≤3	37（52.11）
新辅助化疗		>3且≤6	34（47.89）
是	37（52.11）	既往化疗线数
否	34（47.89）	1线	28（39.44）
初治残留病灶最大径（cm）		2线及以上	43（60.56）
0	10（14.08）	既往贝伐珠单抗用药
≤1	33（46.48）	是	44（61.97）
>1	21（29.58）	否	27（38.03）
未知	7（9.86）	既往PARPi用药
		是	20（28.17）
		否	51（71.83）

指标	ORR	χ²值	P值	DCR	χ²值	P值
HRD状态
阳性	43.75（7/16）			75.00（12/16）
阴性	38.46（5/13）	1.79	0.409	76.92（10/13）	1.13	0.568
未知	57.14（24/42）			85.71（36/42）
铂耐药状态
初治铂耐药	48.78（20/41）	0.14	0.705	80.49（33/41）	0.09	0.759
后线铂耐药	53.33（16/30）	0.14	0.705	83.33（25/30）	0.09	0.759
铂耐药线数
≤2线	52.31（34/65）	0.79	0.374	81.54（53/65）	<0.01	>0.999
>2线	33.33（2/6）	0.79	0.374	83.33（5/6）	<0.01	>0.999
末次铂类化疗至复发时间（月）
≤3	40.54（15/37）	3.19	0.074	72.97（27/37）	3.93	0.048
>3且≤6	61.76（21/34）	3.19	0.074	91.18（31/34）	3.93	0.048
初治残留病灶最大径（cm）
≤1	46.51（20/43）			83.72（36/43）
>1	61.90（13/21）	1.53	0.466	80.95（17/21）	-	0.726
未知	42.86（3/7）			71.43（5/7）
新辅助化疗
否	52.94（18/34）	0.13	0.718	79.41（27/34）	0.23	0.634
是	48.65（18/37）	0.13	0.718	83.78（31/37）	0.23	0.634
2周期后CA125下降率
≥50%	58.70（27/46）	3.34	0.068	86.96（40/46）	2.42	0.120
<50%	36.00（9/25）	3.34	0.068	72.00（18/25）	2.42	0.120
4周期后CA125下降率
≥50%	66.67（30/45）	7.33	0.007	91.11（41/45）	7.84	0.005
<50%	26.67（4/15）	7.33	0.007	60.00（9/15）	7.84	0.005
既往贝伐珠单抗用药
是	38.64（17/44）	6.74	0.009	72.73（32/44）	6.21	0.013
否	70.37（19/27）	6.74	0.009	96.30（26/27）	6.21	0.013
既往PARPi用药
是	45.00（9/20）	0.36	0.547	75.00（15/20）	0.83	0.361
否	52.94（27/51）	0.36	0.547	84.31（43/51）	0.83	0.361

不良反应	1级（例）	2级（例）	3级（例）	4级（例）	5级（例）	总发生率（%）
高血压	10	6	0	0	0	22.54
蛋白尿	22	10	1	0	0	46.48
神经毒性	38	3	0	0	0	57.75
白细胞减少	9	11	3	0	0	32.39
中性粒细胞减少	7	8	10	1	0	36.62
血小板减少	6	1	0	0	0	9.86
肝酶升高	13	1	0	0	0	19.72
恶心呕吐	33	0	0	0	0	46.48
腹泻	6	0	0	0	0	8.45
乏力	12	2	0	0	0	19.72
脱发	2	13	0	0	0	21.13
出血	31	1	0	0	0	45.07
肠穿孔	0	0	0	0	1	1.41