COMMENTARY

Bevacizumab's Role in Late-Stage Cervical Cancer

Maurie Markman, MD

Disclosures

September 24, 2014

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Hello. I am Dr. Maurie Markman from Cancer Treatment Centers of America in Philadelphia. I want to briefly discuss a very important announcement recently made by the US Food and Drug Administration (FDA) regarding the antiangiogenic agent bevacizumab.

This agent, which has been shown to be quite useful in a number of tumor types, was approved by the FDA for use in persistent, recurrent, or metastatic cervix cancer. This is an important development and an acknowledgment of the role that bevacizumab may play in the management of patients with this very difficult malignancy.

Four-Month Survival Benefit

In the pivotal randomized phase 3 trial,[1] patients in the control arm received either cisplatin and paclitaxel or paclitaxel and topotecan. In the experimental arm, they received one of those two chemotherapy regimens plus bevacizumab. The study demonstrated a median improvement in overall survival of approximately four months, which was statistically significant, as well as an increase in the objective response rate. It is always difficult to know what the objective response rate in this setting might mean for an individual patient, but certainly one might suspect that shrinkage of tumor masses in a patient with pain could result in a favorable impact on that very distressing symptom of disease.

Managing Toxicities

The toxicity profile of this regimen was real but generally manageable. Hypertension was seen more commonly in the patients receiving bevacizumab, and a higher incidence of thromboembolic events and fistulas was observed in the bevacizumab-treated patient population.

Knowing the mechanism of the activity of antiangiogenic agents, the presence of fistulas in a previously heavily irradiated area is not surprising. This information suggests that patients who might not be appropriately managed with bevacizumab in this setting include those with pre-existing fistulas that might be draining or infected. The risk associated with adding bevacizumab might be too great.

On the other hand, for a very large percentage of patients with metastatic, recurrent, or persistent cervix cancer, the addition of bevacizumab to these chemotherapy agents demonstrated an improvement in overall survival. It is a very unusual event in cervix cancer management to demonstrate that any regimen can improve survival.

This was a very important observation and announcement by the FDA for clinicians who care for women with this difficult malignancy. This information will be very helpful as it certainly adds another drug to the armamentarium of oncologists in this setting.

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