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Combination of weekly paclitaxel-carboplatin plus standard bevacizumab as neoadjuvant treatment in stage IB–IIB cervical cancer
  1. Charlotte Maene1,
  2. Rawand Rokan Salihi1,
  3. Els Van Nieuwenhuysen1,
  4. Sileny N Han1,
  5. Nicole Concin2 and
  6. Ignace Vergote1
  1. 1 University Hospital Leuven, Department of Gynaecology and Obstetrics, Division of Gynaecological Oncology, Katholieke Universiteit Leuven, Leuven, Flanders, Belgium
  2. 2 Department of Gynaecology and Obstetrics, Innsbruck Medical Univeristy, Innsbruck, Austria
  1. Correspondence to Professor Ignace Vergote, University Hospital Leuven, Department of Gynaecology and Obstetrics, Division of Gynaecological Oncology, Katholieke Universiteit Leuven, Leuven 3000, Flanders, Belgium; ignace.vergote{at}uz.kuleuven.ac.be

Abstract

Objective In this study we investigated response rates of bevacizumab in addition to weekly paclitaxel and carboplatin in neoadjuvant setting in cervical cancer stage IB–IIB.

Methods In this retrospective study we included patients with FIGO 2018 stage IB–IIB cervical cancer. Treatment consisted of 9 weeks' neoadjuvant paclitaxel and carboplatin (paclitaxel 60 mg/m2, carboplatin AUC 2.7; both weekly) and bevacizumab (15 mg/kg every 3 weeks). The radiologic response rate was analyzed using the Response Evaluation Criteria in Solid Tumors (RECIST) v1.1 criteria. The definition of optimal pathological response was complete disappearance of tumor (complete response, pCR) or residual disease with less than 3 mm stromal invasion (pPR1). Suboptimal pathologic response (pPR2) was defined as persistent residual disease with more than 3 mm stromal invasion.

Results A total of 30 patients were included. Six patients had FIGO 2018 stage IB1–IB2 (20%), one had stage IB3 (3%), five had stage IIA (17%), and 18 had stage IIB (60%). After completing the neoadjuvant chemotherapy, all patients showed a RECIST response (seven (23%) complete response; 23 (77%) partial response). Six patients (20%) were judged to be still inoperable. After radical hysterectomy, optimal pathological response was observed in 11 patients (38%) (pCR in nine patients (29%) and pPR1 in two patients (8%)). Six patients (20%) received postoperative adjuvant chemoradiotherapy. Hematological toxicity was similar to neoadjuvant weekly paclitaxel and carboplatin, as we reported earlier. Grade IV proteinuria or hypertension was not observed and no administration of bevacizumab was delayed or dose-reduced.

Conclusion Bevacizumab in addition to weekly paclitaxel and carboplatin showed a 100% radiological RECIST response and an optimal pathological response of 38%. Although bevacizumab has an established role in the treatment of recurrent cervical cancer in combination with paclitaxel and carboplatin, we did not observe a tendency toward superior effect on the pathological response rate of bevacizumab in the neoadjuvant chemotherapy setting.

  • cervical cancer
  • uterine cervical neoplasms

Data availability statement

All data relevant to the study are included in the article.

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Data availability statement

All data relevant to the study are included in the article.

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Footnotes

  • Contributors Dr CM and Prof IV designed the study. They performed data collection from medical files and performed statistical analysis. All authors performed data analysis, interpretation, and approved the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.

  • Competing interests Prof. Em IV reports grants and other from Amgen (Europe) GmbH, personal fees and other from AstraZeneca, other from Clovis Oncology Inc. (2018-2019), other from Carrick Therapeutics (2019), other from Debiopharm International SA (2018), other from Deciphera Pharmaceuticals (2020), personal fees from Elevar Therapeutics (2020), other from F. Hoffmann-La Roche Ltd (2018-2020), other from Genmab (2018–2020), personal fees and other from GSK (2019–2020), personal fees and other from Immunogen Inc. (2018–2020), other from Medical University of Vienna (2018), other from MSD (2018–2020), other from Octimet Oncology NV (2019), personal fees and other from Oncoinvent AS (2018–2020), other from Pharmamar (2018), other from Sotio a.s. (2019), other from Tesaro Inc.(2018–2019), other from Verastem Oncology (2020), grants from Roche, personal fees from Mersana (2020), personal fees from Zentalis (2020), personal fees from Novocure (2020), outside the submitted work.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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