A clinical pathway for postoperative management and early patient discharge: does it work in gynecologic oncology?

OBJECTIVE: This study evaluates a postoperative clinical pathway among gynecologic oncology patients. STUDY DESIGN: 880 surgical admissions were retrospectively reviewed at an institution which used a clinical pathway consisting of early feeding and ambulation as well as prompt discontinuation of intravenous fluids with conversion to oral analgesics. Readmission, mortality, and complication rates were calculated. Patient proportions were compared by using the chi(2), Mann-Whitney, and t tests. RESULTS: 40% of the surgeries were radical and/or staging procedures and 100% underwent open laparotomies. The median length of hospital stay was 2 days. Only 5% required readmission. The median time to readmission was 4 days. Those patients with a longer initial length of hospital stay and higher mean blood loss were more likely to be readmitted (P < .01). The most common diagnosis was endometrial carcinoma (n = 188). This subgroup also had a median length of hospital stay of 2 days and the readmission rate was 3.6%. The perioperative mortality rate was low in the group as a whole with only 1 death (0.2%). There were no reoperations for hemoperitoneum or urinary or intestinal fistulas. CONCLUSION: This management approach resulted in a length of hospital stay of 2 days without increasing morbidity or mortality after laparotomy for suspected gynecologic malignancy.

Salvage bevacizumab (rhuMAB VEGF)-based therapy after multiple prior cytotoxic regimens in advanced refractory epithelial ovarian cancer.

OBJECTIVES: Bevacizumab (BEV) is a humanized monoclonal antibody against vascular endothelial growth factor. We reviewed our experience with BEV in patients with recurrent advanced epithelial ovarian cancer who had failed multiple prior chemotherapeutic regimens. METHODS: Thirty-two patients not participating in an ongoing clinical trial were treated with BEV (15 mg/kg every 3 weeks IV). Demographic and clinicopathologic data, clinical outcomes, and adverse events were extracted from patient charts. RECIST and CA-125 Rustin criteria were retrospectively applied to evaluate response and progression. Median progression-free survival (PFS) and overall survival (OS) were determined using Kaplan-Meier methods. Adverse events were retrospectively categorized using the common terminology criteria for adverse events version 3. RESULTS: The median patient age was 57 years (range 35-80) with 84% being Caucasian and 50% having a GOG performance status of 2. FIGO stages included 80% stage III and 10% stage IV. The tumors were mostly grades 2 (29%) and 3 (64%) and serous histological subtype (69%). All patients had failed multiple prior cytotoxic chemotherapies (median of 5 (range 2-10)) prior to BEV. The median duration of follow-up was 4.8 months (range 0.4-16.3). Twenty-three patients were treated with BEV alone, 2 received BEV with another chemotherapy regimen (5-FU/lecovorin plus oxaliplatin, cyclophosphamide), and 8 initially received BEV alone, followed by BEV with capcitabine, cyclophosphamide, docetaxel, carboplatin, or weekly paclitaxel. A median of 6 cycles (range 1-20) with 196 total doses of BEV was administered. One patient was lost to follow-up after cycle 1. We observed a 16% response rate (all in those treated with BEV alone) with 62.5% of patients demonstrating stable disease. Median OS was 6.9 months, and the median PFS was 5.5 months. Three grade 3 and no grade 4 adverse events were observed. Grade 3 toxicities included hypertension, proteinuria, and enterocutaneous fistula. The fistula occurred after 5 cycles of BEV in a patient who had undergone 7 debulking surgeries prior to BEV. CONCLUSIONS: BEV is generally well tolerated after multiple prior cytotoxic regimens and results in significant clinical benefit among women with recurrent ovarian cancer.

Activity of bevacizumab (rhuMAB VEGF) in advanced refractory epithelial ovarian cancer.

BACKGROUND: Angiogenesis is pivotal in the development and progression of ovarian cancer and is an ideal candidate for novel treatment approaches. CASE: A case of advanced, recurrent and refractory serous carcinoma is presented that responded to bevacizumab 15 mg/m2 intravenously every 3 weeks after failing eleventh line cytotoxic chemotherapy and radiation. An objective durable response lasting at least 5 months was documented. CONCLUSION: Bevacizumab has activity in epithelial ovarian carcinoma and larger scale trials are indicated.