Bevacizumab improves survival for patients with recurrent and metastatic cervical cancer

Findings show first advance in treatment of advanced disease in decades

Patients with advanced, recurrent, or persistent cervical cancer that was not curable with standard treatment who received the drug bevacizumab (Avastin) lived 3.7 months longer than patients who did not receive the drug according to findings from a large, randomized clinical trial. 

The clinical trial, known as GOG240, was sponsored by the National Cancer Institute, part of the National Institutes of Health, and conducted by a network of researchers led by the Gynecologic Oncology Group.  Genentech, South San Francisco, Calif., the drug manufacturer, provided support for the trial under the Cooperative Research and Development Agreement (CRADA) with NCI for the clinical development of bevacizumab.

The study met its primary endpoint of demonstrating improved overall survival in patients who received bevacizumab, which also means that it delayed the chance of dying from the disease.

“The findings in this clinical trial are important because they are likely to change clinical practice and provide an opportunity to improve outcome in patients with recurrent cervical cancer who have previously had very limited treatment options,” said GOG study chair Krishnansu S. Tewari, M.D., associate professor in the UCI Health Department of Obstetrics & Gynecology.

These results were released, based on an interim analysis, in February 2013, and updates were presented as part of the American Society of Clinical Oncology annual meeting in Chicago on June 2, 2013.

Patients, whose median age was approximately 47 years old, received a dose of 15 milligrams per kilogram (mg/kg) of body weight of bevacizumab administered in the vein with their chemotherapy treatment and continued with this dose one day every three weeks until disease progression or unacceptable toxicity occurred.  Those patients lived a median 3.7 months longer than those who did not receive bevacizumab. Patients treated with chemotherapy alone had a median survival of 13.3 months while those who received chemotherapy and bevacizumab had a median survival of 17 months. This survival difference was highly statistically significant.  Progression free survival, meaning that after treatment the disease did not worsen, was 8.2 months for those who received bevacizumab vs. 5.9 months for those who received chemotherapy alone.

However, patients receiving bevacizumab experienced more side effects than those who did not. These side effects were consistent with side effects previously known to be associated with bevacizumab and included hypertension, neutropenia (a low white blood cell count), and thromboembolism, or formation of blood clots.  Quality of life during the trial was also measured and there was no significant difference reported by patients between those who received bevacizumab and those who received chemotherapy alone.

A total of 452 patients in the United States and Spain with metastatic, recurrent, or persistent cervical cancer not curable with standard treatment were enrolled between 2009 and 2012. The trial was designed to answer two questions: Whether topotecan in combination with paclitaxel was superior to cisplatin and paclitaxel in combination, and whether the addition of bevacizumab to either regimen improved overall survival.

Patients were randomly assigned to one of four treatment groups; two of the treatment groups received bevacizumab. In an analysis conducted in 2012, it was determined that topotecan plus paclitaxel was not superior to the standard therapy of cisplatin plus paclitaxel and investigators and patients were notified of the finding at that time. 

The purpose of bevacizumab is to block the blood supply that feeds the tumor. The drug originally was approved for certain types of metastatic cancer in combination with chemotherapy and is designed to bind to and inhibit vascular endothelial growth factor (VEGF). VEGF is a protein that plays a critical role in tumor blood vessel growth.

“This is welcome news as progress has been very difficult against this cancer, and GOG physicians and patients who participated have made an important contribution,” said Jeff Abrams, M.D., clinical director of NCI’s Division of Cancer Treatment and Diagnosis.

It is estimated that over 12,000 women will be diagnosed with cervical cancer in the United States in 2013 and over 4,000 women will die of the disease.

The trial is GOG240, Paclitaxel and Cisplatin or Topotecan With or Without Bevacizumab for Treating Patients With Stage IVB, Recurrent, or Persistent Cervical Cancer, clinical trial registry number NCT00803062.  It was presented as Abstract 3 at the ASCO plenary on June 2, 2013.

UCI Health comprises the clinical, medical education and research enterprises of the University of California, Irvine. Patients can access UCI Health at physician offices throughout Orange County and at its main campus, UC Irvine Medical Center in Orange, Calif., a 412-bed acute care hospital that provides tertiary and quaternary care, ambulatory and specialty medical clinics, behavioral health and rehabilitation. U.S. News & World Report has listed it among America’s Best Hospitals for 12 consecutive years. UC Irvine Medical Center features Orange County’s only National Cancer Institute-designated comprehensive cancer center, high-risk perinatal/neonatal program, Level I trauma center and Level II pediatric trauma center, and is the primary teaching hospital for UCI Health School of Medicine. UCI Health serves a region of more than 3 million people in Orange County, western Riverside County and southeast Los Angeles County.

GOG 240 is a randomized phase III trial of cisplatin plus paclitaxel with and without NCI-supplied bevacizumab (NSC #704865, IND #113912) versus the non-platinum doublet, topotecan plus paclitaxel, with and without NCI-supplied bevacizumab, in stage IVB, recurrent or persistent carcinoma of the cervix. The full protocol for this trial can be found at http://clinicaltrials.gov/ct2/show/NCT00803062.

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