Maene Charlotte, Salihi Rawand Rokan, Van Nieuwenhuysen Els, Han Sileny N, Concin Nicole, Vergote Ignace
University Hospital Leuven, Department of Gynaecology and Obstetrics, Division of Gynaecological Oncology, Katholieke Universiteit Leuven, Leuven, Flanders, Belgium.
Department of Gynaecology and Obstetrics, Innsbruck Medical Univeristy, Innsbruck, Austria.
Int J Gynecol Cancer. 2021 Jun;31(6):824-828. doi: 10.1136/ijgc-2021-002432. Epub 2021 Apr 15.
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.
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/m, 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.
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.
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.
在本研究中，我们调查了在新辅助治疗中，贝伐单抗联合每周一次的紫杉醇和卡铂用于IB-IIB期宫颈癌的缓解率。
在这项回顾性研究中，我们纳入了国际妇产科联盟（FIGO）2018年IB-IIB期宫颈癌患者。治疗方案包括9周的新辅助紫杉醇和卡铂（紫杉醇60mg/m，卡铂曲线下面积2.7；均为每周一次）以及贝伐单抗（每3周15mg/kg）。使用实体瘤疗效评价标准（RECIST）v1.1标准分析放射学缓解率。最佳病理缓解的定义为肿瘤完全消失（完全缓解，pCR）或残留病灶的间质浸润小于3mm（pPR1）。次优病理缓解（pPR2）定义为持续残留病灶的间质浸润大于3mm。
共纳入30例患者。6例为FIGO 2018年IB1-IB2期（20%），1例为IB3期（3%），5例为IIA期（17%），18例为IIB期（60%）。完成新辅助化疗后，所有患者均显示出RECIST缓解（7例（23%）完全缓解；23例（77%）部分缓解）。6例患者（20%）被判定仍无法手术。根治性子宫切除术后，11例患者（38%）观察到最佳病理缓解（9例（29%）为pCR，2例（8%）为pPR1）。6例患者（20%）接受了术后辅助放化疗。血液学毒性与我们之前报道的新辅助每周一次的紫杉醇和卡铂相似。未观察到IV级蛋白尿或高血压，且未延迟贝伐单抗给药或降低剂量。
贝伐单抗联合每周一次的紫杉醇和卡铂显示出100%的放射学RECIST缓解率以及38%的最佳病理缓解率。尽管贝伐单抗在联合紫杉醇和卡铂治疗复发性宫颈癌中已确立了作用，但在新辅助化疗环境中，我们未观察到贝伐单抗对病理缓解率有更优效果的趋势。
