Real-World Efficacy and Safety of Bevacizumab in the First-Line Treatment of Metastatic Cervical Cancer: A Cohort Study in the Total Population of Croatian Patients

Dora Čerina; Višnja Matković; Kristina Katić; Ingrid Belac Lovasić; Robert Šeparović; Ivana Canjko; Blanka Jakšić; Branka Petrić-Miše; Žarko Bajić; Marijo Boban; Eduard Vrdoljak

doi:10.1155/2021/2815623

Real-World Efficacy and Safety of Bevacizumab in the First-Line Treatment of Metastatic Cervical Cancer: A Cohort Study in the Total Population of Croatian Patients

J Oncol. 2021 Aug 5:2021:2815623. doi: 10.1155/2021/2815623. eCollection 2021.

Affiliations

¹ Department of Oncology, University Hospital Center Split, School of Medicine, University of Split, Spinčićeva 1, HR-21000 Split, Croatia.
² Department of Gynecologic Oncology, University Hospital Center Zagreb, Petrova 13, HR-10000 Zagreb, Croatia.
³ Department of Radiotherapy and Oncology, University Hospital Center Rijeka, Krešimirova 42, HR-51000 Rijeka, Croatia.
⁴ Department of Medical Oncology, Division of Medical Oncology, University Hospital for Tumors, Sestre Milosrdnice University Hospital Center, Ilica 197, HR-10000 Zagreb, Croatia.
⁵ Department of Radiotherapy Oncology, University Hospital Center Osijek, Josipa Huttlera 4, HR-31000 Osijek, Croatia.
⁶ Department of Oncology and Nuclear Medicine, University Hospital Center Zagreb, Kišpatićeva 12, HR-10000 Zagreb, Croatia.
⁷ Research Unit "Dr. Mirko Grmek", University Psychiatric Hospital "Sveti Ivan", Jankomir 11, HR-10.090 Zagreb, Croatia.

Abstract

Background: Although today it is almost preventable, cervical cancer still represents a significant cancer burden, especially in some developing parts of the world. Since the introduction of bevacizumab in the first-line treatment of metastatic disease, improvements of the outcomes were noted. However, results from randomized controlled trials are often hard to recreate in the real-world setting.

Objective: To assess the real-world efficacy and safety of bevacizumab as a first-line treatment of advanced cervical cancer.

Methods: We conducted a retrospective cohort study on the total population of Croatian patients diagnosed with metastatic cervical cancer from 2016 to 2019 who were treated with bevacizumab in combination with cisplatin and paclitaxel (TCB) in the first line. The comparison group was the consecutive sample of patients treated with chemotherapy alone. The primary endpoint was overall survival (OS). Secondary endpoints were progression-free survival (PFS), objective response rate, incidence of adverse events, and the proportion of treatment discontinuation.

Results: We enrolled 67 patients treated with TCB and a control group of 62 patients treated with chemotherapy alone. The TCB cohort had significantly longer unadjusted OS with a median of 27.0 (95% CI 18.5; not calculable) months, compared to 15.5 (10.7; 30.1) months in the chemotherapy-alone cohort. Adjusted OS was not significantly different. PFS was significantly longer for the TCB cohort, with a median of 10.6 (95% CI 8.5; 15.4) months, than for the chemotherapy-alone cohort, with a median of 5.4 (95% CI 3.9; 9.1) months, even after adjustment for baseline covariates (HR_adjusted = 0.60; 95% CI 0.39; 0.94; p=0.027; false discovery rate <5%).

Conclusions: In a real-world setting, TCB as a first-line treatment of metastatic cervical cancer was associated with longer PFS, better objective disease control rate, and acceptable toxicity profile in comparison to chemotherapy alone. These results may indicate its utility and potential applicability in other parts of the developing world.