Characterizing bevacizumab use in endometrial cancer in a community medical setting

Abstract

Objectives: Given that 85% of cancer patients are treated in community settings and the role of bevacizumab in the treatment of endometrial cancer is undefined, we sought to characterize the practice patterns of bevacizumab use in recurrent or persistent endometrial cancer in a community based integrated health care system. Methods: Following IRB approval, patients with endometrial cancer and prior treatment with bevacizumab were identified within the cancer registry database from our regional medical institution. Patients were excluded if they had a concurrent or prior cancer. A chart reviewof the eligible patients was performed to extract traditional clinical variables. Bevacizumab side effects were also recorded to assess tolerability. Results: Twenty-two patients were identified with recurrent or persistent endometrial cancer treated with bevacizumab. The average age was 64 years (range 38–79). Twenty-seven percent were Stage 1, 50% were Stage 3, and 23% were Stage 4. Histology types included 36% papillary serous, 32% endometriod, 9% clear cell, 5% adenosquamous, 5% carcinosarcoma, and 13% with mixed histologic components. The average time period for bevacizumab treatment was 134 days (range 22–374). The average number of chemotherapy treatments prior to bevacizumab use was 2 treatments (range 0–5). Fifty percent of patients received bevacizumab as part of a multidrug treatment regimen, 27% received it as monotherapy, and 22% received additional therapeutic agents during part of their treatment regimen with bevacizumab. Chemotherapy treatments were overseen by 13 medical oncologist and 3 gyn oncologists. Progressive diseasewas seen in 64% of patients using bevacizumab, while 27% had stable disease and 9% has partial or complete regression. Five patients (23%) had Grade 3/4 bevacizumab side effects, including three patients with hypertension, one subarachnoid hemorrhage, and one fistula. No deaths were attributed to bevacizumab. Conclusion: Bevacizumab is well tolerated in this heavily pretreated population, and utilized in varied combinations with clinical benefit. Further studies are needed to elucidate a standard treatment regimen which may optimize patient outcomes in this population with poor prognosis. Learning objective: Learners will be able to describe the role of bevacizumab in recurrent endometrial cancer in patientswho are treated in a community setting.