Background. Although today it is almost preventable, cervical cancer still represents a significant cancer burden, especially in some developing parts of the world. Since the introduction of bevacizumab in the first-line treatment of metastatic disease, improvements of the outcomes were noted. However, results from randomized controlled trials are often hard to recreate in the real-world setting. Objective. To assess the real-world efficacy and safety of bevacizumab as a first-line treatment of advanced cervical cancer. Methods. We conducted a retrospective cohort study on the total population of Croatian patients diagnosed with metastatic cervical cancer from 2016 to 2019 who were treated with bevacizumab in combination with cisplatin and paclitaxel (TCB) in the first line. The comparison group was the consecutive sample of patients treated with chemotherapy alone. The primary endpoint was overall survival (OS). Secondary endpoints were progression-free survival (PFS), objective response rate, incidence of adverse events, and the proportion of treatment discontinuation. Results. We enrolled 67 patients treated with TCB and a control group of 62 patients treated with chemotherapy alone. The TCB cohort had significantly longer unadjusted OS with a median of 27.0 (95% CI 18.5; not calculable) months, compared to 15.5 (10.7; 30.1) months in the chemotherapy-alone cohort. Adjusted OS was not significantly different. PFS was significantly longer for the TCB cohort, with a median of 10.6 (95% CI 8.5; 15.4) months, than for the chemotherapy-alone cohort, with a median of 5.4 (95% CI 3.9; 9.1) months, even after adjustment for baseline covariates (HRadjusted = 0.60; 95% CI 0.39; 0.94; p = 0.027 ; false discovery rate <5%). Conclusions. In a real-world setting, TCB as a first-line treatment of metastatic cervical cancer was associated with longer PFS, better objective disease control rate, and acceptable toxicity profile in comparison to chemotherapy alone. These results may indicate its utility and potential applicability in other parts of the developing world.

Low-grade serous ovarian cancer (LGSOC) has less aggressive behavior and a better clinical outcome than high-grade serous ovarian cancer (HGSOC). Considering that this malignancy is relatively chemoresistant, surgery is the keystone of treatment, with a strong recommendation for maximal cytoreduction. Women with stage IA-IB disease should undergo observation alone after primary cytoreductive surgery. In contrast, observation, chemotherapy, or endocrine therapy are possible options for those with stage IC-IIA disease. Patients with stage IIB-IV disease receive either chemotherapy with carboplatin and paclitaxel for six cycles followed by endocrine therapy, most commonly with aromatase inhibitors, or endocrine therapy alone until disease progression or unacceptable toxicity. Surgery, chemotherapy, and endocrine therapy are also used in patients with recurrent disease. Targeted agents, especially mitogen-activated protein kinase (MEK) inhibitors and cyclin-dependent kinase (CDK) inhibitors, are currently under evaluation in this clinical setting. Additional research on the genomics of LGSOC to better define the activating gene mutations involved in the carcinogenesis is strongly warranted to improve the prognosis with this malignancy.

Ovarian cancer is the fifth most common cause of death among malignant diseases in women in Europe. The standard treatment is cytoreductive surgery, followed by platinum-taxane based chemotherapy. In patients with advanced disease, a valid option is a neoadjuvant chemotherapy followed by interval debulking surgery. Despite the progress in primary treatment, almost 70% of the patients relapse. There is a significant need for better first-line treatment to avoid or delay relapse and improve ovarian cancer outcomes. The most significant change involves the changes in the treatment schedule and new drugs in first-line chemotherapy. Bevacizumab is approved in first-line treatment combined with carboplatin and paclitaxel as it improves progression-free survival (PFS) in patients with a higher risk of recurrence. After achieving the response to first-line chemotherapy, maintenance therapy with poly-adenosine-diphosphate-ribose-polymerase (PARP) inhibitors prolongs PFS in patients with homologous recombination deficiency (HRD). Patients with BRCA mutations obtain the most significant benefit.

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