A number of studies have evaluated the effectiveness of combining standard chemotherapy with bevacizumab in patients with ovarian cancer. In Europe, the European Medicines Agency has approved bevacizumab in combination with carboplatin and paclitaxel for newly diagnosed ovarian cancer, bevacizumab in combination with gemcitabine for platinum-sensitive recurrent ovarian cancer, and bevacizumab in chemotherapy for patients with platinum-resistant ovarian cancer. In the United States, the FDA has approved bevacizumab for use in the chemotherapy of patients with platinum-resistant recurrent ovarian cancer. These departmental approvals were based on studies confirming that bevacizumab prolongs progression-free survival (FPS) in patients. However, no studies to date have demonstrated that the addition of bevacizumab to chemotherapy prolongs overall survival (OS) in the overall study population. In The Lancet Oncology, Amit Oza et al. reported on an open randomized phase 3 clinical trial, ICON7, in which they explored the effect of bevacizumab plus 6 cycles of carboplatin combined with paclitaxel combination chemotherapy on OS compared to conventional carboplatin plus paclitaxel chemotherapy regimens. The study included patients with newly diagnosed ovarian cancer after tumor cytoreductive surgery or patients with advanced ovarian cancer who were lost to surgical indications. The study’s primary observational endpoint, FPS, has been previously reported and is consistent with the results of GOG-218, another phase 3 clinical trial comparing bevacizumab in combination with chemotherapy to chemotherapy alone in the pre-treatment of patients with ovarian cancer. Trial results: in the overall study population, FPS was 21.8 months in the bevacizumab group versus 20.3 months in the chemotherapy alone group; in patients with stage III or IV ovarian cancer with high-risk factors, after unsatisfactory tumor cytoreduction, FPS was 18.1 months in the bevacizumab combination chemotherapy group versus 14.5 months in the chemotherapy alone group.ICON7 was similarly designed and obtained for total survival OS and reported complete data. Oza et al. found that bevacizumab combined with standard chemotherapy did not improve OS in the overall study population (limiting mean survival: 44.6 months in the chemotherapy alone group, [95% CI 43.2-45.9]; 45.5 months in the bevacizumab group, [95% CI 44.2-46.7]). However, they found that OS was indeed prolonged in a study subgroup that included 502 high-risk patients with stage III or IV ovarian cancer who were unable to undergo surgery or had unsatisfactory tumor reduction results. The mean OS was 34.5 months in the chemotherapy alone group, [95% CI 32.0-37.0]; compared with 39.3 months in the bevacizumab group, [95% CI 43.2-45.9], a significant difference (log-rank p=0-03). In contrast, no significant benefit in OS was found in other subgroups, including the clear cell group, the early high-grade group and the low-grade plasmacytic group. Improving overall survival is a very important goal when selecting a treatment for patients with newly diagnosed ovarian cancer. Therefore, the results of the study by Oza et al. beg the question: can bevacizumab actually be used as a first-line treatment for some ovarian cancer patients with a high risk of recurrence?The results of GOG-218, a cause-and-effect exploratory study with a sample similar to that of Oza et al. (patients with stage III or IV ovarian cancer with unsatisfactory results of tumor reduction), suggest that bevacizumab combined with chemotherapy had a nonsignificant prolongation of OS, with a median OS of 38.6 months in the chemotherapy alone group compared to 42.1 months in the bevacizumab group (HR=0.86, CI 0-71-1-04; p=0-055). Combining these findings with the clinical context, we still need to consider the use of different treatment options for patients with newly diagnosed advanced ovarian cancer. The chemotherapy regimen used in the ICON7 trial was carboplatin plus paclitaxel three-week therapy, and the JGOG-3016 trial completed by Katsumata et al. reported that the use of paclitaxel weekly therapy instead of three-week therapy significantly prolonged PFS and OS, especially in the setting of unsatisfactory tumor cytoreduction, with a median OS extension from 33.5 to 51.2 months (HR=0-75 , [95% CI 0-57-0-97]; p=0-0027). GOG-262 likewise compared the effect of carboplatin plus paclitaxel weekly therapy with carboplatin plus paclitaxel three-week therapy, and added bevacizumab according to the trialists’ judgment. The results showed that when bevacizumab was combined with weekly paclitaxel, there was no prolongation of FPS, and the small group of patients who received only weekly paclitaxel without bevacizumab had FPS similar to those treated with weekly paclitaxel plus bevacizumab. It is worth mentioning that neoadjuvant chemotherapy plus IDS surgery to reduce operative mortality is also an option in patients with advanced ovarian cancer. However, the long half-life and side effects of bevacizumab lead to many limitations in its use in neoadjuvant chemotherapy. Therefore, clinicians are still facing a huge challenge – how to establish the appropriate first-line treatment for patients with newly diagnosed advanced ovarian cancer. Although the results of ICON7 look very tempting and the results suggest that certain patients can have prolonged OS with first-line use of bevacizumab, we should remain cautious about the interpretation of the results of the subgroup analysis. There are many unanswered questions about the use of bevacizumab in patients with newly diagnosed ovarian cancer, and only a small proportion of patients in ICON7 received bevacizumab after recurrence, so it remains unclear whether bevacizumab provides an OS benefit when used in patients with recurrence. More studies are needed to understand the impact of postoperative treatment with bevacizumab on survival. Further confirmation and identification of molecular markers associated with anti-angiogenic therapy is also necessary to deepen our understanding of the use of bevacizumab therapy in patients with ovarian cancer.