Bevacizumab is associated with a higher gastrointestinal/genitourinary fistula or perforation risk in cervical cancer patients undergoing pelvic radiotherapy

Abstract

BackgroundBevacizumab serves as an effective treatment in cervical cancer patients with metastatic, recurrent, or advanced disease. However, gastrointestinal (GI)/genitourinary (GU) toxicities have been observed after bevacizumab treatment. Radiotherapy (RT) is the mainstay of treatment of cervical cancer.ObjectivesTo investigate the risk of GI/GU toxicities with bevacizumab plus RT compared with RT alone in cervical cancer patients.Search StrategyIn this meta‐analysis, PubMed, Embase, Web of Science, and Cochrane databases were searched from inception to September 25, 2022.Selection CriteriaCohort studies evaluating the association between bevacizumab and GI/GU fistula or perforation in irradiated metastatic, recurrent, or advanced cervical cancer patients.Data Collection and AnalysisResults are expressed as odds ratios (OR) with 95% confidence intervals (CI). The inconsistency test (I2) was used to assess heterogeneity. Egger's regression test with a two‐tailed P value was used to evaluate publication bias.Main ResultsFour cohort studies met the inclusion criteria with a total of 597 women included. There was a significant association between GI fistula/perforation and GU fistula/perforation in irradiated cervical cancer patients receiving bevacizumab (OR 4.03 [95% CI: 1.76–9.20] and OR 4.71 [95% CI: 1.51–14.70], respectively).ConclusionsThe bevacizumab‐containing regimen was associated with an increased risk of GI or GU toxicities in cervical cancer individuals undergoing pelvic RT. These results suggest the bevacizumab‐associated benefits and risk should be better weighted to reach an optimal treatment strategy. Further investigation on optimal dosage and timing of bevacizumab and RT is vital to minimize the adverse events and maximize the benefits.

Winners of the 2023 honor awards for excellence at the annual meeting of the Chinese Medical Association-Taipei: Part I

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The present editorial is a "Part I," focusing on the recent advance of cancer treatment. 1,[6][7][8][9][10] Conventionally, treatment opinions have limited to surgery, radiotherapy, and chemotherapy before. Although the majority of them, if localized tumor or early-stage cancers are diagnosed, can be successfully managed by three aforementioned strategies, there is no doubt that for a substantial number of women presenting with persistent, recurrent and/or metastatic cancers the prognosis is extremely poor, and rarely these advanced cancer patients could have the median overall survival more than 1 year, suggesting that new prognostic information-or personalized biomarkers-driven approach treatment is urgently needed.Herein, we are happy to introduce the exciting works from the "Winners" of the 2023 honor awards for excellence at the annual meeting of the Chinese Medical Association-Taipei.

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