COMMENTARY

The Year in Gynecologic Cancer: Bevacizumab and Beyond

Maurie Markman, MD

Disclosures

December 19, 2014

Editor's Note: 2014 saw significant developments in the treatment of gynecologic cancers, including the expansion of bevacizumab's indication for both cervical and ovarian cancer. Medscape asked Dr Maurie Markman to provide his perspective on bevacizumab's expanded role and other important clinical developments in the field of gynecologic cancer this past year.

Cervical Cancer

Probably the single most important paper in cervical cancer was the publication of the results of the Gynecologic Oncology Group study that examined the clinical utility of adding the antiangiogenic agent bevacizumab to cytotoxic chemotherapy in the management of recurrent or metastatic cervical cancer.[1] The chemotherapy backbone was cisplatin plus paclitaxel or topotecan plus paclitaxel. (Note: This study also compared the relative activity of these two combination chemotherapy strategies and found no difference between the two regimens.)

The addition of bevacizumab to chemotherapy was shown to improve the objective response rate (48% vs 36%; P = .008); time to disease progression (median: 8.2 months vs 5.9 months; hazard ratio [HR], 0.67; P = .002); and, most important, overall survival (median: 17.0 months vs 13.3 months; HR, 0.71; P = .004). The delivery of the antiangiogenic agent in combination with chemotherapy was associated with an anticipated increased risk for hypertension (> grade 2: 25% vs 2%), gastrointestinal fistulas (> grade 3: 3% vs 0%) and thromboembolic events (> grade 3: 8% vs 1%).

These data suggest that caution is advised when using bevacizumab in the presence of pre-existing fistulas or evidence of deep venous thrombosis. These situations are not uncommon in women with persistent or metastatic cervix cancer.

Recognizing the favorable impact of adding bevacizumab to cytotoxic chemotherapy in the management of metastatic cervical cancer, the US Food and Drug Administration (FDA) formally approved bevacizumab for this indication on August 14.

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