Endostar, an Antiangiogenesis Inhibitor, Combined With Chemoradiotherapy for Locally Advanced Cervical Cancer

Abstract

This phase II randomized clinical trial aimed to assess the efficacy and toxicity of Endostar, an anti-angiogenesis inhibitor, combined with concurrent chemoradiotherapy (CCRT) for locally advanced cervical cancer (LACC). Patients with LACC were randomly assigned to either CCRT plus Endostar(CCRT+E arm) or CCRT alone (CCRT arm). All patients received pelvic intensity-modulated radiation therapy (IMRT)and brachytherapy. Weekly cisplatin was administered concurrently with IMRT. Patients in the CCRT+E arm also received concurrent Endostar every 3 weeks for 2 cycles. The primary endpoint was progression-free survival (PFS) and acute toxicities. The exploratory endpoint was the impact of vascular endothelial growth factor receptor-2 (VEGFR2) expression on long-term survival. A total of 116patientswere enrolled. Patients in the CCRT+E arm and in the CCRT arm had similar acute and late toxicity profile. The 1-and 2-year PFS were 91.4% vs. 82.1% and 80.8% vs. 63.5%（p=0.091）, respectively. The1-and 2-year distance metastasis-free survival （DMFS）were92.7% vs. 81.1% and 86.0% vs. 65.1%（p=0.031）, respectively. Patients with positive VEGFR2 expression had significant longer PFS and overall survival (OS), compared with those with negative VEGFR2 expression. Patients in the CCRT+E arm had significantly longer PFS, OS, and DMFS than those in the CCRT arm whenVEGFR2 expression was positive. In conclusion, CCRT plus Endostar significantly improved DMFS but not PFS over CCRT alone. The addition of Endostar could significantly improve survival for patients with positive VEGFR2 expression.

Bevacizumab Combined with Intensity-Modulated Radiation Therapy on Cognitive and Coagulation Function in Postoperative Glioma Patients

“…Bevacizumab [ 23 ] is a targeted drug that specifically antagonizes VEGF and can produce biological effects that bind to VEGF and antagonize its promotion of angiogenesis. More and more data indicate that the combination of antiangiogenesis and chemoradiotherapy may improve the therapeutic effect [ 24 ]. This study was for clarifying the application value of bevacizumab + IMRT in cases with postoperative glioma.…”

Efficacy of concurrent chemoradiotherapy plus Endostar compared with concurrent chemoradiotherapy in the treatment of locally advanced nasopharyngeal carcinoma: a retrospective study

“…The incidence of grade 3 or 4 leukopenia in CCRT + E is highly variable across studies, ranging from 5.3 to 44.8% [15,[34][35][36], which may be related to different chemotherapy regimens and cycles, Endostar cycles, and radiotherapy doses. In this study, the incidence of grade 3/4 leukopenia in the CCRT + E group was 32.6%, but all patients recovered with symptomatic management, and no patient interrupted or discontinued treatment, and no patient died of acute toxic events.…”

Efficacy and safety of endostar combined with chemoradiotherapy versus chemoradiotherapy alone in locally advanced cervical cancer: A PRISMA-compliant systematic review and meta-analysis

“…In the NRCT group, endostar combined CCRT did not increase the treatment-related adverse reactions of patients compared with the CCRT group, and the differences were not statistically significant. In cohort studies, endostar combined CCRT increased the probability of diarrhea and radiation proctitis (P < .05), Lu et al [16] 2017.01-2020.01 RCT 66/32 12/6 0 IB2-IVA 78/38 E + CCRT (cisplatin, qw) CCRT (cisplatin, qw) Chen and Fu [17] 2016 Dili et al [18] Tang [19] 2017.07-2018.11 NRCT 27/27 3/3 0 IIB-IVA 30/30 E + CCRT (DDP, qw) CCRT (DDP, qw) Xu et al [20] [21] 2013.02-2014.02 RCT 20/21 8/7 0 IIB-IVA 28/28 E + CCRT (DDP, qw) CCRT (DDP, qw) Luo [22] 2011.01-2014.01 RCT 20/22 13/11 0 IIB-IVA 33/33 E + CCRT (liposome, qw) CCRT (liposome, qw) Liu et al [23] Ke et al [24] 2009. [15] 2019.06-2020.12 RCT 48/43 0 0 IB3-IVA 48/43 E + CCRT (TP) CCRT (TP) Zhao et al [25] Unknown RCT 15/15 5/5 5/5 IIB-IV 25/25 E + CCRT (DDP qw + Hu po bid) CC (DDP qw + Hu po bid)…”