Looking at the current treatment landscape in metastatic cervical cancer, experts consider the role of frontline chemotherapy and antiangiogenesis therapy.
Bradley Monk, MD, FACOG, FACS:Let’s transition to first-line metastatic cervical cancer. This can be either de novo stage IVB or recurrent cancer after chemotherapy and radiation. We call this first line. We don’t count chemotherapy or radiation as a line of therapy. Warner, we’ve established a historical chemotherapy backbone. Tell us about that historical chemotherapy backbone in first-line metastatic cervical cancer, and it’s a global standard.
Warner K. Huh, MD, FACOG, FACS:I feel a little weird telling you this because you’re the father behind it. Not long ago, we were excited about giving topotecan and platinum to the patient. With respect to the late Harry Long, who was central to that, we were making very minor incremental gains in cervical cancer. Then we looked at Taxol [paclitaxel] and platinum, and that has largely become the de facto standard—still to this day—with or without bevacizumab. Worldwide, that’s what people use widely for their first-line therapy. For the listeners, it’s important to recognize that we were originally using a cisplatin backbone and the JGOG [Japanese Gynecologic Oncology Group] trial demonstrated noninferiority between carboplatin and cisplatin, except for those people who had not received cisplatin previously as a part of their RT [radiation therapy] planning. It’s pretty much paclitaxel, platinum, and bevacizumab. You were central to a lot of that work, and that’s step-wise progression of how we got to where we are.
Bradley Monk, MD, FACOG, FACS:That’s nice of you, but Krish Tewari is going to talk next. Platinum-taxane and carboplatin have an AUC [area under the curve] generally is 5 mg/mL, and paclitaxel is 175 mg over 3 hours. Krish, it became a bevacizumab world with your passion, your hard work, and the GOG 240 trial. GOG 240 was the first targeted therapy in a gynecologic cancer. Tell us about your study. It’s our study; it’s a team effort. Tell us about GOG 240 and what that did to the world.
Krishnansu S. Tewari, MD:It was a team effort. We wrote the study in 2006, released it in 2009, and had the results in 2013. It showed that by incorporating antiangiogenesis therapy into platinum and nonplatinum chemotherapy doublets, we could significantly improve survival in women with recurrent metastatic cervix cancer in the first line.
Bradley Monk, MD, FACOG, FACS:How much?
Krishnansu S. Tewari, MD:3.7 months.
Bradley Monk, MD, FACOG, FACS:It’s not enough, but it’s an incremental step. Bhavana, who’s the right patient for bevacizumab? Not everyone is a good candidate. Who’s the right patient for bevacizumab added to, let’s say, carboplatin-paclitaxel?
Bhavana Pothuri, MD:Anyone who’s not at risk for a bowel perforation is an ideal candidate. Given that these patients have had radiation, I’ve seen a higher incidence of fistulas forming.
Bradley Monk, MD, FACOG, FACS:True.
Bhavana Pothuri, MD:That can significantly affect their quality of life. There’s a real benefit, but I’m thoughtful about that when I’m counseling patients.
Bradley Monk, MD, FACOG, FACS:Bhavana, what percentage of patients do you think in your system get chemotherapy-bevacizumab first line?
Bhavana Pothuri, MD:We utilize it quite frequently. About 85% of my patients will get the triplet.
Bradley Monk, MD, FACOG, FACS:Warner, what do you think?
Warner K. Huh, MD, FACOG, FACS:I agree. It’s extremely high.
Bradley Monk, MD, FACOG, FACS:Krish, I don’t mean to put you on the spot, but how many countries do you think bevacizumab is approved in?
Krishnansu S. Tewari, MD:When we stopped counting, it was 60. That was 5 years ago.
Bradley Monk, MD, FACOG, FACS:All right. Well, it’s never enough.
Transcript edited for clarity.