Bevacizumab in Metastatic, Recurrent, or Persistent Cervical Cancer: The BC Cancer Experience

Abstract

ObjectiveWe conducted a population-based analysis of patient outcomes following treatment with bevacizumab and platinum–based chemotherapy for metastatic, recurrent, or persistent cervical carcinoma.MethodsEligible cases were identified using the BC Cancer provincial pharmacy database. Cases with small cell component or inadequate clinical follow-up were excluded. Overall response to therapy, progression-free survival (PFS), overall survival (OS), and toxicities were documented.ResultsTwenty-seven eligible cases were included with a median follow-up of 12.1 months. The median age at recurrence/metastatic diagnosis was 49 years (range, 27–83 years). Twenty-three of 27 women received carboplatin, paclitaxel, and bevacizumab as first-line treatment, and 4 of 27 as second-line treatment. The median number of cycles of bevacizumab delivered was 5.5 (range, 1–21). The overall response rate was 44% (12/27), with 11% (3/27) complete response and 33% (9/27) partial response. Median PFS and OS for the entire cohort were 5.3 and 12.1 months, respectively. In first-line therapy, the median PFS and OS were 6.3 and 17.5 months, respectively. Common toxicities included anemia (grade 1/2) 73% (19/27), and the following grade 2 or greater: neutropenia 38% (n = 10) with 1 occurrence of febrile neutropenia, hypertension 30% (n = 8), and thrombosis 22% (n = 6). The fistula rate was 3.7% (n = 1).ConclusionsIn this population-based analysis, the combination of bevacizumab and platinum–based chemotherapy as first-line therapy for metastatic, recurrent, or persistent cervical carcinoma was safely delivered and had outcomes comparable to results from the GOG 240 phase III trial.

Bevacizumab Efficacy and Recurrence Pattern of Persistent and Metastatic Cervical Cancer

“…However, the outcomes for first-line treatment in previous clinical studies were consistent with the GOG 240 study. Compared with a median OS of 17.5 months reported by Tinker et al (8), we found a median OS of 18.2 months in primary treatment.…”

“…In our review of 52 patients, there were only two fistula cases reported (3.8%), one involving a genitourinary fistula and one involving a rectovaginal fistula. By comparison, Tinker et al reported a fistula rate of 3.7% (n=1) (8). This finding occurred in a frontline, real-world practice setting, and adverse events rarely led to treatment discontinuation.…”

“…In this study, the OS was shorter than that reported in the GOG 240 study. Godoy-Ortiz et al reported a median OS of 21.5 months (2), whereas Tinker et al reported a median OS of 12.1 months (8). The results in 'real-world' patients differed from those in the GOG240 randomized controlled trial.…”

“…Surgery, chemo-radiation, or the combination provide an effective cure of early-stage and locally advanced cervical cancers (5,6). The failure rate in treatment is 15-30% for International Federation of Gynecology and Obstetrics (FIGO) stage I-II disease and 40-60% for stage III disease (7,8). However, treatment options for patients with recurrence, distant metastasis (FIGO stage IVB) or nonresectable local recurrence are limited, with a poor prognosis and a 5-year survival rate of 5-15% (5,6,(8)(9)(10).…”

Pharmacological Treatment of Patients with Metastatic, Recurrent or Persistent Cervical Cancer Not Amenable by Surgery or Radiotherapy: State of Art and Perspectives of Clinical Research

“…According to a systematic review of 23 studies, CDDP + PTX + BEV and topotecan + PTX + BEV were likely to prolong OS compared with non–BEV-containing therapies, and CDDP + PTX + BEV had the highest probability of being the most efficacious regimen [ 112 ]. Response rates and fistula rates with CBDCA + PTX + BEV are similar to those reported with CDDP + PTX + BEV [ 114 , 115 ]. The risks and benefits of the addition of BEV to chemotherapy should be exhaustively discussed with the patient herself, taking into account the increased probability of fistula formation, especially in the case of locally persistent or recurrent disease after radiotherapy or CCRT [ 116 , 117 , 118 ].…”