GOG 240 Study
Improved Survival with Bevacizumab in Advanced Cervical Cancer

Disease site


Publication month/year


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. 
CT only group CT bevacizumab group
Overall Survival (Months)
Response Rate %
Hypertension Grade ≥ 2
Thromboembolic Events Grade ≥ 3
Gastrointestinal Fistulas
  • 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.
Reviewer name