Survival advantage of bevacizumab rechallenge in recurrent ovarian cancer regardless of platinum sensitivity

Bevacizumab has demonstrated significant efficacy in both first-line and recurrent settings of epithelial ovarian cancer; however, evidence regarding the benefit of bevacizumab retreatment after prior exposure in real-world populations remains limited. This study aimed to evaluate the efficacy of bevacizumab retreatment compared with nonbevacizumab regimens in recurrent metastatic ovarian carcinoma, irrespective of platinum sensitivity status. This retrospective single-center study included 133 patients with recurrent epithelial ovarian cancer who had previously received bevacizumab-containing first-line therapy between January 2015 and May 2025. Patients were grouped according to second-line treatment: bevacizumab-containing chemotherapy ( n = 51) or chemotherapy alone ( n = 82). Patients undergoing secondary cytoreductive surgery were excluded. Progression-free survival (PFS) and overall survival (OS) were analyzed using Kaplan-Meier and Cox regression models. Median PFS-2 after second-line treatment was significantly longer in the bevacizumab group compared with the nonbevacizumab group (9.7 vs. 3.0 months; P < 0.001). This benefit was consistent across both platinum-sensitive and platinum-resistant subgroups. Multivariate analysis confirmed that omission of bevacizumab independently predicted worse PFS-2 (hazard ratio = 3.33, 95% CI: 2.17-5.11, P < 0.001). Although OS-2 was numerically longer in the bevacizumab group (14.1 vs. 8.2 months), the difference was not statistically significant ( P = 0.091). Bevacizumab retreatment following prior first-line use was associated with improved PFS regardless of platinum sensitivity, suggesting a potential survival advantage in recurrent ovarian cancer. Prospective, randomized studies including both platinum-sensitive and platinum-resistant patients with larger sample sizes are warranted to confirm these findings and determine the optimal use of bevacizumab beyond first-line therapy.