GOG 240 Study
Improved Survival with Bevacizumab in Advanced Cervical Cancer

Disease site

Cervix

Publication month/year

February/2014

Study question

Evaluation the effectiveness of bevacizumab and nonplatinum combination chemotherapy in patients with recurrent, persistent, or metastatic cervical cancer.

Type of study

RCT: 2-by-2 factorial design.

Interventions compared
  •  Cisplatin and paclitaxel vs. Topotecan and paclitaxel.
  • Both regimens was studied with and without bevacizumab.
Experimental arm (Intervention)
  1. Control treatment + bevacizumab. (CT+B)
  2. Nonplatinum combination chemotherapy. (NP)
  3. Nonplatinum combination chemotherapy with bevacizumab. (NP+B)
Control arm

Cisplatin and paclitaxel. (CT)

Primary outcome
  • Overall survival
  • The frequency and severity of adverse events associated with each regimen.
Secondary outcome

Progression-free survival and response rate.

Inclusion criteria
  • Metastatic, persistent, or recurrent cervical carcinoma.
  • Adequate renal, hepatic, and bone marrow function.
  • Measurable disease.
Exclusion criteria
  • Being a candidate for curative therapy by means of pelvic exenteration.
  • Patients treated with chemotherapy for recurrence and those with nonhealing wounds, active bleeding, or inadequately anti coagulated for thromboembolism. 
Results
CT only group CT bevacizumab group
Overall Survival (Months)
13.3
17
Response Rate %
36%
48%
Hypertension Grade ≥ 2
2%
25%
Thromboembolic Events Grade ≥ 3
1%
8%
Gastrointestinal Fistulas
0%
3%
Conclusions
  • The addition of bevacizumab to combination chemotherapy in patients with recurrent, persistent, or metastatic cervical cancer was associated with an improvement of 3.7 months in median overall survival.
  • As compared with cisplatin–paclitaxel (either with or without bevacizumab) topotecan–paclitaxel was associated with a significantly higher risk of progression (hazard ratio, 1.39; 95% confidence interval [CI], 1.09 to 1.77) but it did not affect OS. 
Study limitations
  • Patients with advanced cervical cancer usually do not have a sustained response to chemotherapy and cannot receive multiple lines of chemotherapy because of unacceptable side effects.
  • Data are lacking on drugs that inhibit angiogenesis through non–VEGF-dependent pathway, as well as vascular disrupting agents.
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