Combined Modality of Bevacizumab With Radical Radiotherapy and Chemotherapy in the Treatment of Refractory Cervical Cancer.

PURPOSE/OBJECTIVE(S) Cervical cancer with bulky primary tumor, regional lymph node metastasis, oliog-distant metastasis, non-squamous carcinoma and huge pelvic relapse after radical surgery are defined as refractory cervical cancer (RCC). Patients with RCC were traditionally treated by concurrent chemoradiotherapy, with limited effectiveness. RTOG 0417 was the first and the only trial used bevacizumab in LACC patients' initial treatment but did not meet the "refractory" criteria. This study aimed to evaluate the safety and effectiveness of bevacizumab combining radical chemoradiotherapy in RCC. MATERIALS/METHODS 129 patients with cervical cancer between Jan 2016 and Dec 2019 were enrolled for retrospective analysis in our institutions. All patients were administered with radical concurrent chemoradiotherapy. Sixty-four of 129 patients were treated with bevacizumab combining chemoradiotherapy. Treatment response was evaluated by RECIST 1.1 criteria. The Cox proportional hazard was analyzed for all patients and tumor response during treatment was analyzed for patients treated with bevacizumab. RESULTS 1. Univariate and multivariate analyses about overall survival of 129 patients showed that bevacizumab was a prognostic factor for refractory cervical cancer receiving radical chemoradiotherapy (P = 0.017). 2. With a median follow-up of 24.1 months, the 3-year overall survival (OS), locoregional relapse-free survival (LRFS) and distance metastasis free survival (DMFS) for the 64 patients treated with bevacizumab were 87.2%, 98.1% and 81%. The 3-y OS for patients had achieved cCR before brachytherapy (BT) was higher than others. 3. In all 64 patients treated with bevacizumab, tumor median volume before treatment, after NAT (Neoadjuvant treatment) and before BT were 61.26 cm3 (25.19-264.8 cm3), 3.19 cm3 (0-71.84 cm3) and 0 cm3 (0-13.43 cm3), respectively. Tumor regression rates of 90.16% (35.21-100%) after NAT and 100% (74.06-100%) before BT were calculated. Accordingly, tumor cCR rates were 37.8% (17/45) after NAT and 62.5% (40/64) before BT. 4. Sixty-four patients treated with bevacizumab were well tolerated. Grade 3 or 4 hematological toxicity occurred in 43.8% (28/64) patients. Grade 3 GI toxicity occurred in 3 (4.7%) patients. CONCLUSION Bevacizumab combining concurrent chemoradiotherapy was a safe and tolerable treatment option for refractory cervical cancer, with quicker tumor regression, high OS, LRFS and DMFS. AUTHOR DISCLOSURE H. Yang: None. Y. Zhang: None. C. Liu: None. L. Zhao: None. L. Wei: None.