Improved Survival with Bevacizumab in Advanced Cervical Cancer (GOG240)
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.
- Cisplatin and paclitaxel vs. Topotecan and paclitaxel.
- Both regimens was studied with and without bevacizumab.
Experimental arm (Intervention)
- Control treatment + bevacizumab. (CT+B)
- Nonplatinum combination chemotherapy. (NP)
- Nonplatinum combination chemotherapy with bevacizumab. (NP+B)
Cisplatin and paclitaxel. (CT)
- Overall survival
- The frequency and severity of adverse events associated with each regimen.
Progression-free survival and response rate.
- Metastatic, persistent, or recurrent cervical carcinoma.
- Adequate renal, hepatic, and bone marrow function.
- Measurable disease.
- 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.
|Chemotherapy-alone group||Chemotherapy-plus-bevacizumab group|
|Randomised (n0)||CT (114) / NP (111)||CT + B (115) / NP + B (112)|
|Overall survival P=0.004||13.3 months||17 months|
|Response rate P=0.008||36%||48%|
|Hypertension Grade >=2||2%||25%|
|Thromboembolic events Grade >=3||1%||8%|
- 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.
- 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.