Bevacizumab Not Beneficial in Subset of Cervical Cancer Patients
By identifying patients with cervical cancer as low, intermediate, or high-risk, physicians can determine whether bevacizumab will provide survival benefit.
A clinical trial has prospectively validated a set of 5 clinical prognostic criteria designed to identify which patients with advanced cervical cancer are most likely to benefit from treatment.1
A previous trial found that bevacizumab, an angiogenesis inhibitor, was associated with improved survival in patients with advanced cervical cancer.2 This trial showed that while the drug provided significant survival benefit to moderate- and high-risk patients as assessed by the criteria, it did not provide benefit to low-risk patients.
A total of 462 patients enrolled in the trial were assessed using the Moore criteria, a set of 20 clinical factors, 5 of which are prognostic: performance status greater than 0, pelvic disease, African American ancestry, disease-free interval less than 1 year, and prior platinum exposure. Factors were equally weighted and patients were categorized as low risk if they had 0 to 1 factors, mid-risk if 2 to 3 factors, and high-risk if 4 to 5.
Primary endpoints were overall survival and the frequency and severity of toxicity. Progression-free survival and response rate were secondary endpoints, while validation of the Moore criteria was a tertiary endpoint.
“The nice thing about the Moore criteria is they're easy,” said Krishnansu Tewari, MD, of the University of California, Irvine Medical Center in Orange, CA, in an interview with Cancer Therapy Advisor.
“You don't have to do any other tests; it's not expensive and it's easy to do. [Physicians] can add up the clinical scoring and then just go to the chart in the manuscript, and they can literally predict what the patient survival on bevacizumab is – not only their overall survival but also their progression-free survival and the response rate.”
“In this country and in many developed countries, cervical cancer rates are on the decline,” he added, “and when diseases become less common people forget how to treat them, so this is a very easy way to help drive treatment.”
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Dr Tewari said that he thinks it would be interesting to develop an equivalent to the Moore criteria for other cancers to determine whether prognostic criteria could be found for those populations.
“We need an effective, predictive scoring system that's easy to use because medicine is so expensive,” he said. “In some patients this will justify using an expensive drug…while in other patients it will justify not using it.”