In the phase II OCTAVIA trial, the efficacy of the experimental regimen with bevacizumab (six to eight cycles of bevacizumab with weekly paclitaxel 80 mg/m² and carboplatin [AUC6], followed by bevacizumab alone 7.5 mg/kg q3w for up to 1 year) was similar between patients <65 years old and patients ≥65 years old (with a median PFS of 23.7 and 20.5 months for patients <65 years old and patients ≥65 years old, respectively) [10]. In the two large phase III trials evaluating bevacizumab as first-line therapy in combination with chemotherapy and as maintenance therapy in previously untreated ovarian cancer patients (GOG0218 and ICON7), the PFS of older patients was prolonged with the combination therapy followed by bevacizumab maintenance (versus chemotherapy alone) [11, 12]. In GOG0218, > 300 patients (17 % of the study population) were 70 years old or older (1.7 % were more than 80 years old). In terms of histological profile, elderly patients reported more primary peritoneal disease compared to patients less than 60 (NS). There was a significant improvement in terms of PFS with HR = 0.68 for the experimental arm with the maintenance therapy compared to the control arm (chemotherapy alone) [11]. The subgroup analysis of PFS by treatment arm and age reported a similar effect whatever is the age class for patients receiving bevacizumab compared to placebo. HR is 0.81, 0.76, and 0.79 for age class less than 60, 60–69, and 70 or older, respectively, in the bevacizumab arm compared to placebo. There is no detrimental effect also in terms of overall survival using bevacizumab also in the group of patients of 70 years old and more (HR 0.99) compared to placebo. However, age and performance status remain prognostic factors for overall survival in this clinical trial. In the ICON7 trial, 150 patients (10 % of the study population) were 70 years old or older. There was a nonsignificant improvement in terms of progression-free survival, with HR = 0.82 [0.51–1.30] [12].

In the OCEAN trial and the AURELIA trial, bevacizumab was evaluated in the relapsed setting. In the OCEAN trial, patients with platinum-sensitive recurrence received carboplatin plus gemcitabine chemotherapy ± bevacizumab followed by maintenance therapy with either bevacizumab or placebo; 178 patients (37 % of the study population) were 65 years old or older. The magnitude of benefit obtained in the bevacizumab arm (compared to the chemotherapy alone arm) was similar between the group of patients <65 years old and the group of patients ≥65 years old (HR = 0.47 [0.36–0.62] and 0.50 [0.34–0.72], respectively) [13]. In the AURELIA trial, patients with platinum-resistant recurrent ovarian cancer received single-agent chemotherapy ± bevacizumab; 133 patients (37 % of the study population) were 65 years old or older. The median PFS was significantly improved with chemotherapy plus bevacizumab (versus chemotherapy alone); however, the subgroup analysis by age did not show a statistically significant improvement when comparing the two treatment arms (HR = 0.82 [0.61–1.10] for patients <65 years old and HR = 0.95 [0.62–1.46] for patients ≥65 years old) [14].

Taken together, these data showed that the benefit from adding bevacizumab treatment to standard chemotherapy as observed in the general population may be also applied to the subpopulation of patients aged over 65 years. Age per se is not an absolute contraindication for bevacizumab.