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Surgery and chemoradiotherapy are often curative for patients with early-stage and locally advanced cervical cancer; however, the treatment of patients with metastatic or recurrent disease after platinum-based chemoradiation remains a major challenge, with limited treatment options available. A number of Gynecologic Oncology Group (GOG) studies have demonstrated that paclitaxel plus cisplatin is superior to other platinum-based doublets. Additionally, this treatment approach appears to be similar, if not superior, to non-platinum doublet, such as paclitaxel and topotecan, explains James Tate Thigpen, MD.
Further research has shown that the addition of bevacizumab to the cisplatin doublet provides an added survival advantage. After the recurrence of disease on the paclitaxel, cisplatin, and bevacizumab regimen, the next option may be single-agent topotecan or bevacizumab, notes Michael J. Birrer, MD. In August 2014, the FDA approved bevacizumab in combination with paclitaxel plus cisplatin or topotecan as a treatment for women with persistent, recurrent, or metastatic cervical cancer. This was based on findings from the GOG-240 study.
In this study, bevacizumab combined with chemotherapy improved overall survival by 26% compared with chemotherapy alone in patients with advanced cervical cancer. Additionally, the objective response rate was superior with the addition of bevacizumab (45% vs 34%).
In women who have recurrences, states Warner K. Huh, MD, there is a risk of fistula formation with bevacizumab. In the GOG-240 study, genitourinary and gastrointestinal fistulas occurred in approximately 6% of patients, Robert A. Burger, MD, notes. Thrombosis was also a concern, with 8% in the bevacizumab arm and 1% in the control arm; however, the more concerning adverse event were the significantly higher rates of hypertension in the treatment group (25%) versus the control group (2%). Most of the side effects that occurred in the trial were manageable and did not lead to treatment discontinuation.