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Neoadjuvant chemotherapy with bevacizumab for locally advanced vulvar cancer
  1. Theresa M Kuhn1,
  2. Sarfraz Ahmad1,
  3. Fernando O Recio1,
  4. Ahmad Awada1,
  5. Nathalie D McKenzie1,
  6. James E Kendrick1,
  7. Andrew Keller2 and
  8. Robert W Holloway1
    1. 1 Gynecologic Oncology, AdventHealth Cancer Institute, Orlando, Florida, USA
    2. 2 Radiation Oncology, AdventHealth Cancer Institute, Orlando, Florida, USA
    1. Correspondence to Dr Theresa M Kuhn, Gynecologic Oncology, AdventHealth Cancer Institute, Orlando, FL 32804, USA; tmkuhn2{at}gmail.com

    Abstract

    Objectives External beam radiation with sensitizing platinum is the recommended therapy for locally advanced vulvar cancers not amenable to curative surgery and is associated with considerable acute and chronic side effects. Radical vulvectomy post-radiation for persistent disease is often compromised with poor wound healing. We describe clinical outcomes for patients who received neoadjuvant chemotherapy plus bevacizumab followed by radical vulvectomy for locally advanced vulvar cancer.

    Methods We performed retrospective analyses of all patients at our institution who underwent radical vulvectomy from January 2015 to November 2023. Of 113 patients, 13 patients underwent neoadjuvant chemotherapy. Demographics and clinicopathologic data were extracted, and descriptive statistical analyses were performed. Cases with neoadjuvant chemotherapy plus bevacizumab were further evaluated for response, adverse effects, and survival.

    Results Neoadjuvant chemotherapy was administered to 13 patients with stage II-IV disease that involved the urethra, vagina, or anus. Lesion sizes ranged from 4 to 20 cm (median 7 cm). Patients received 2–6 cycles of carboplatin or cisplatin, paclitaxel, and bevacizumab. Nine (69.2%) patients had partial pathologic responses, and four patients had complete responses. All patients had negative surgical margins. Ten (76.9%) patients had radiographic evidence of inguinal lymph node metastasis prior to neoadjuvant chemotherapy, and four had residual nodal disease. Only one patient developed a superficial groin seroma. Three patients developed recurrence, two locally and one distant, and there was one death. The median follow-up was 23 months (range 6–84 months).

    Conclusions Neoadjuvant chemotherapy using combination platinum/paclitaxel/bevacizumab was efficacious for locally advanced vulvar cancer, resulting in complete resections, negative margins, and excellent wound healing. A multi-institutional phase II trial is warranted to validate these findings.

    • Vulvar Neoplasms
    • Radiotherapy
    • Surgical Procedures, Operative

    Data availability statement

    Data are available upon reasonable request.

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    Data availability statement

    Data are available upon reasonable request.

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    Footnotes

    • X @TheresaMKuhnMD, @NathalieMckenz3

    • Contributors TMK and RWH conceived and designed the study, with TMK serving as the primary author of the finished product and the guarantor. All the co-authors have also diligently contributed to the development and preparation of this research article, including the literature review, concept organization, data interpretation, and writing process. All the authors have read and approved the final draft for publication.

    • 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 None declared.

    • 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.