Bevacizumab Improves Survival but Reduces Quality of Life in Late-Stage Cancer Patients

Patients with stage IVB, recurrent, or persistent cervical cancer that was not cured with standard treatment who were given the angiogenesis inhibitor bevacizumab lived 3.7 months longer than patients who did not receive the drug, according to a press release highlighting the findings of an interim analysis of a large randomized clinical trial.¹ In the United States alone, it is estimated that a diagnosis of cervical cancer will be made in more than 12,000 women in 2013 and that the cancer will be fatal in more than 4000 women.
   
The clinical trial, called GOG240, was led by the Gynecological Oncology Group and supported by Genentech, Inc, the drug’s manufacturer, through the Cooperative Research and Development Agreement with the National Cancer Institute.¹ The trial involved 452 women from the United States and Spain who had late-stage cervical cancer that was resistant to standard chemotherapy. In the patients who were randomized to receive bevacizumab, the drug was administered intravenously with their chemotherapy treatment and given at a dosage of 15 mg/kg of body weight once every 3 weeks until disease progression or until the occurrence of unacceptable toxicity.
   
The median survival of patients who received bevacizumab in addition to standard chemotherapy was 17 months, compared with a median survival of 13.3 months for patients who received chemotherapy alone. This 3.7-month difference in median survival was highly statistically significant, the researchers reported. However, more adverse effects were experienced by patients who were given bevacizumab.
   
Bevacizumab works by blocking the blood supply that feeds the tumor. Bevacizumab binds to and inhibits vascular endothelial growth factor, which is a protein that is critically involved in tumor blood vessel growth. Currently, bevacizumab has been approved by the FDA for the treatment of metastatic colorectal cancer, advanced nonsquamous non-small cell lung cancer, metastatic renal cell carcinoma, and glioblastoma.²
   
In an unrelated study, researchers found that bevacizumab is associated with a clinically significant decline in quality of life in women with advanced ovarian cancer.³ “The trade-off between the prolongation of progression-free survival and the quality of that period of time needs to be considered in clinical practice when making treatment decisions,” wrote the study authors.³ Whether this finding will translate to patients with advanced cervical cancer requires additional study.

Pertinent Points:
- Bevacizumab, given in addition to standard chemotherapy, significantly improves survival in patients who have persistent, recurrent, metastatic cervical cancer.
- More adverse effects were experienced by patients receiving both bevacizumab and standard chemotherapy than by patients receiving standard chemotherapy alone.
- A possible decline in quality of life should be discussed with patients before bevacizumab use.
 

References:

1. National Institutes of Health. Bevacizumab significantly improves survival for patients with recurrent and metastatic cervical cancer. Available at: http://www.nih.gov/news/health/feb2013/nci-07.htm. Accessed February 21, 2013.
2. Avastin [prescribing information]. San Francisco: Genentech; 2013. Available at: http://www.gene.com/download/pdf/avastin_prescribing.pdf. Accessed March 8, 2013.
3. Stark D, Nankivell M, Pujade-Lauraine E, et al. Standard chemotherapy with or without bevacizumab in advanced ovarian cancer: quality-of-life outcomes from the International Collaboration on Ovarian Neoplasms (ICON7) phase 3 randomised trial. Lancet Oncol. Jan 7, 2013. pii: S1470-2045(12)70567-3. doi: 10.1016/S1470-2045(12)70567-3. [Epub ahead of print]