Bevacizumab in Advanced Cervical Cancer

The FDA approved bevacizumab in combination with paclitaxel plus cisplatin or topotecan as a treatment for patients with persistent, recurrent, or metastatic cervical cancer in August 2014, based on the phase III GOG 240 study. Although both regimens are approved, the more commonly administered regimen is cisplatin and paclitaxel, notes Bradley J. Monk, MD.

In the GOG 240 trial, the addition of bevacizumab, an anti-VEGF monoclonal antibody, to chemotherapy in recurrent, persistent, or metastatic cervical cancer improved overall survival (OS) by 3.9 months. The median OS was 16.8 months with bevacizumab compared with 12.9 months for chemotherapy alone (HR = 0.74; 98% CI, 0.58-0.94; P = .0132).

The study also revealed an association between gastrointestinal perforations, vaginal fistulas, and bevacizumab therapy. While gastrointestinal perforations are generally lethal, says Monk, vaginal fistulas may not be lethal but are catastrophic, commenting that is important for clinicians to weigh the 8% vaginal fistula rate against the nearly 4-month improvement in OS.