Bevacizumab Advanced Cervical Cancer Survival Benefits Not at Cost of HRQoL

Bevacizumab may increase advanced cervical cancer survival without further reducing health-related quality of life

medwireNews: Patients with advanced cervical cancer may derive survival benefits from combining chemotherapy with bevacizumab without experiencing additional deficits in their health-related quality of life (HRQoL), phase III trial patient-reported findings suggest.

Initial findings from the Gynecologic Oncology Group protocol 240 (GOG 240) study indicated that adding the Vascular endothelial growth factor inhibitor to chemotherapy significantly increased overall survival from 13.3 to 17.0 months compared with chemotherapy alone in patients with stage IVB or metastatic, recurrent or persistent cervical cancer.

Now, the researchers report that Functional Assessment of Cancer Therapy–Cervix Trial Outcome Index (FACT–Cx TOI) scores for 390 of the GOG 240 patients who completed the assessment at baseline and on at least one later timepoint indicate that “the addition of bevacizumab did not adversely affect quality of life”.

“Although patients living for 3.7 months longer might be another small incremental improvement, if this survival gain is considered in context of a sustained quality of life, the therapeutic effect becomes clinically meaningful”, say Richard Penson, from Massachusetts General Hospital in Boston, USA, and co-authors in The Lancet Oncology.

Patients given bevacizumab scored, on average, 1.2 points lower on the FACT–Cx TOI than those given chemotherapy alone at each of the five assessments from baseline to 9 months after the first chemotherapy cycle. But although both groups experienced reductions in HRQoL over time, the difference in HRQoL between the groups were not significant.

After adjusting for baseline score and patient age, there was no significant difference in FACT–Cx TOI scores for patients given bevacizumab and those given chemotherapy alone, regardless of whether chemotherapy consisted of cisplatin plus paclitaxel or topotecan plus paclitaxel.

Nevertheless, the researchers note that the 2.1-point reduction in FACT–Cx TOI for patients given cisplatin plus paclitaxel with bevacizumab versus those given chemotherapy alone “could be regarded as an improvement” despite not meeting the prespecified difference required for a clinically significant benefit.

“This could be interpreted as encouraging for the development of combination of bevacizumab with the less toxic and equally effective carboplatin–paclitaxel combination”, the team notes. “However, carboplatin-related haematological toxicity can be substantial when patients have previously been treated with chemoradiotherapy, and this treatment approach should not yet be viewed as standard.”

The researchers also discovered significant relationships between HRQoL and both survival and the risk of progression, so that each 10 unit increment in FACT–Cx TOI score was associated with significant hazard ratios of 0.80 for death and 0.88 for progression.

Noting the current lack of treatment options for this patient population, they continue: “The extended overall survival time provides a window of opportunity for patients who derive benefit from anti-angiogenic therapy to be treated with other classes of anti-angiogenic or targeted therapies, or immunotherapy.”

Reference

Penson RT, Huang HQ, Wenzel LB, et al. Bevacizumab for advanced cervical cancer: patient-reported outcomes of a randomised, phase 3 trial (NRG Oncology-Gynecologic Oncology Group protocol 240). Lancet Oncol 2015; Online First 28 January. DOI: dx.doi.org/10.1016/S1470-2045(15)70004-5

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