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ESMO 2014: Adding Cediranib to Chemotherapy Improves Progression-Free Survival in Metastatic or Recurrent Cervical Cancer

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Key Points

  • The addition of cediranib to chemotherapy resulted in a modest but statistically significant increase in median progression-free survival for patients with recurrent or metastatic cervical cancer.
  • Patients who received cediranib in addition to chemotherapy had a better overall response rate compared to those treated with chemotherapy plus placebo (66% vs 42%).
  • There was no statistically significant difference in median overall survival.

For patients with recurrent or metastatic cervical cancer, adding the experimental drug cediranib to standard chemotherapy improved tumor shrinkage and resulted in a modest improvement in progression-free survival, researchers reported at the ESMO 2014 Congress in Madrid (Abstract LBA25_PR).

In Europe, about 70% of patients with cervical cancer are cured by either surgery or chemoradiotherapy. Those patients with recurrent or secondary cancer have a very poor outlook: Only about 20% to 30% have tumor shrinkage after conventional chemotherapy, and survival is usually less than 1 year.

“Cervical cancers with a well-developed blood supply can have a particularly bad outcome. The experimental drug cediranib blocks the cell surface receptor VEGF, which stimulates the growth of new blood vessels to feed the growth of tumors,” explained study author Paul Symonds, MD, FRCP, FRCR, of the Department of Cancer Studies & Molecular Medicine at the University of Leicester, United Kingdom.

Phase II CIRCCa Trial

In the phase II CIRCCa trial, researchers compared two groups of patients with relapsed or metastatic cervical cancer given conventional chemotherapy with carboplatin and paclitaxel plus either cediranib (n = 34) or placebo (n = 35).

Patients who received cediranib in addition to chemotherapy had a better overall response rate compared to those treated with chemotherapy plus placebo (66% vs 42%). There was also a modest but statistically significant increase in median progression-free survival (35 vs 30 weeks). There was no statistically significant difference in median overall survival.

One month into treatment, VEGF receptor 2 levels in blood were more likely to be reduced in cediranib group (median change in log10 VEGFR-2 from baseline, 0.036 vs 0.067).

Side effects, particularly hypertension and diarrhea were increased in patients taking cediranib and were treated with standard medication.

Targeting the tumor blood supply seems to be a promising way to increase the effectiveness of chemotherapy in cervical cancer, Dr. Symonds said. “Recurrent or metastatic cervix cancer is really difficult to treat with a low response rate and poor survival. This study has opened up a new avenue of investigation for a difficult-to-treat cancer.”

The researchers are now conducting an individual patient analysis to correlate response to chemotherapy with the fall in VEGFR receptor levels in the blood. They are also looking at other tumor biomarkers that may have been reduced by cediranib.

Continued Benefit of Antiangiogenic Drugs in Cervical Cancer

Commenting on the study, Andrés Poveda, MD, Head of the Gynecologic Oncology Clinic at Fundación Instituto Valenciano de Oncología, Valencia, Spain, who was not involved in the research, said the CIRCCa study is the second recent trial to show the benefit of adding an antiangiogenic drug to chemotherapy in cervical cancer.

“The impact on progression-free survival is important, and other trial objectives were reached, such as response rate,” Dr. Poveda said.

He also noted that recent years have been positive for the treatment of cervical cancer. “For 2 decades, advances in treatment for patients with advanced cervical cancer had been slow and scarce,” he said. “Between 1989 and 2009, modifications of chemotherapy regimens resulted in an increased survival rate of just 4 months. Then the first study to include an antiangiogenic drug, bevacizumab [Avastin], obtained spectacular results, offering a survival benefit of 4 months in one study—which is the equivalent to that obtained over the previous 20 years.”

“The FDA recently approved the use of bevacizumab as it completely changed clinical practice,” Dr. Poveda added. “We are now waiting for phase III results to confirm the favorable predictions of this treatment with cediranib.”

For full disclosures of the study authors, view the study abstract at www.esmo.org.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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