Abstract 286MO
Background
Cervical cancer is the second most common cancer in women in India. Recurrent / metastatic (R/M) cervical cancer carries a poor prognosis with median overall survival of 11 months with chemotherapy alone. Checkpoint inhibitors added to chemotherapy have improved survival. However, the current approved dose is accessible to only 1-3% of patients in low- and middle-income countries because of their cost. Nivolumab does not have a dose-response relationship; therefore, a low dose regimen may be a viable option to reduce financial burden and improve access.
Methods
This is a retrospective study from a single tertiary centre in India from 1/3/2020 to 30/6/2023. Patients with R/M cervical cancer who received low dose Nivolumab as they could not afford to pay for standard Nivolumab dose were analyzed. Response rates and Progression free survival (PFS) were measured.
Results
A total of 20 patients who received low dose Nivolumab were identified during the study period whose mean age was 54.3 years. 75% had ECOG of Patient and tumor characteristics
| Characteristic | nivolumab | |
| N | % | |
| Age (years) | ||
| 40-49 | 8 | 40 |
| 50-59 | 6 | 30 |
| 60-69 | 5 | 25 |
| 70-79 | 1 | 5 |
| Performance status | ||
| 0,1 | 15 | 75 |
| >/= 2 | 5 | 25 |
| Histology | ||
| Squamous | 14 | 70 |
| Non- squamous | 6 | 30 |
| Prior surgery | ||
| Yes | 17 | 85 |
| No | 3 | 15 |
| Prior RT | ||
| Yes | 17 | 85 |
| No | 3 | 15 |
| Prior chemotherapy | ||
| None | 6 | 30 |
| I line | 11 | 55 |
| II lines | 3 | 15 |
| Backbone chemotherapy with Nivolumab | ||
| Platinum based | 11 | 55 |
| None | 5 | 25 |
| Others | 4 | 2 |
The average number of doses received were 4.75 and the mean dose received was 0.84mg/kg. Overall responses were seen in 10 patients (50%) out of which 5 (50%) had stable disease and 5(50%) had a complete response. Median progression free survival was 7.97 months. Treatment related adverse events (TRAE) were seen in 8 patients (40%), out of which most of them are grade 1 and 2. 3 (15%) patients had grade 3 TRAE. No grade 4 and 5 adverse events were recorded.
Conclusions
In patients with R/M cervical cancer, Low dose Nivolumab is effective with manageable toxicity. It can help reduce financial toxicity and make it accessible to more patients especially in low- and middle-income countries where the burden of this disease is higher.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
S. Devabhaktuni.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.
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