The refractory malignant ascites is a complication of advanced stages of many cancer types.
It is characterized clinically by abdominal pressure sensation, shortness of breath and
pelvic pain. Thus, it contributes to decreased quality of life for these patients in
Conventional treatment is based on paracentesis of ascites. The progression of the disease
leads to increased production of ascites requiring more frequent paracentesis. Main
therapeutic alternatives are constituted by the controversial use of diuretics and the use of
an antibody inhibiting the activity of the Vascular Endothelial Growth Factor (VEGF):
bevacizumab. Catumaxomab, a monoclonal antibody anti-EpCAM and CD3, developed for the
treatment of refractory malignant ascites showed no sufficient clinical benefit.
VEGF is overexpressed in many tumors. VEGF causes an increase in capillary permeability and
capillary filtration surface generating increased protein extravasation. These phenomena are
responsible for an increase of the volume of ascites product. Thus the use of inhibitors of
VEGF, such as bevacizumab, could reduce the production of ascites.
The efficacy of bevacizumab to decrease the volume of ascites product was demonstrated on
small animals in intraperitoneal administration.
Studies in humans are few and the doses used are not consistent from one study to another.