About 15 to 60% of patients with
cervical cancer develop recurrent of their cancer. Patients with local/central (in the uterus,
vagina) locations has potential curative chance with more radical surgery
(pelvic exenteration). Patients with
multiple or distant metastases, unfortunately, are difficult to cure.
A recent study presented at the 2013
ASCO meeting (GOG 240) randomized 452 women with recurrent cervical cancer to
chemotherapy with or without bevacizumab. Previous platinum-based therapy was
administered with RT in 75 and 74 percent of patients, respectively. Patients who received Bevacizumab (Avastin)
has an improvement in overall survival compared to chemotherapy alone (median,
17 versus 13 months, respectively; hazard ration [HR] 0.71, 95% CI 0.54-0.94).
However, Bevacizumab also increases
toxicities such as serious (grade 3/4) bleeding (5 versus 1 percent), venous
thromboembolic disease (9 versus 2 percent), and the occurrence of
gastrointestinal fistula (3 versus 0 percent). However, there was no difference
between the study arms in quality of life up to nine months following the start
of therapy. The conclusion of the study is bevacizumab has an important role in
patients with recurrent cervical cancer.
Reference: Tewari KS, Sill M, Long HJ, et al.
Incorporation of bevacizumab in the treatment of recurrent and metastatic
cervical cancer: A phase III randomized trial of the Gynecologic Oncology
Group. J Clin Oncol 31, 2013 (suppl; abstr 3).
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