Patient characteristics, treatment patterns and clinical outcomes among patients with previously treated recurrent or metastatic cervical cancer: a community oncology-based real-world analysis

Abstract

<h3>Objectives:</h3> The GOG240 trial introduced a doublet chemotherapy with bevacizumab as the new standard of care for first-line (1L) recurrent or metastatic cervical cancer (r/mCC). While this regimen has been shown to prolong survival compared with chemotherapy alone in this advanced population, there is no standard systemic treatment for r/mCC after failure of 1L. The objectives of this study were to characterize the real-world patient characteristics, treatment patterns, and clinical outcomes of patients who initiated second-line (2L) therapy for r/mCC in the US community oncology setting. <h3>Methods:</h3> This was an observational study of women with r/mCC who initiated 2L systemic therapy within the US Oncology Network (USON) between 2014 and 2019. USON's electronic health record was used to identify eligible patients and abstract data. Overall survival (OS), time to treatment discontinuation (TTD), and time to first subsequent treatment (TFST) were estimated using Kaplan-Meier methods. <h3>Results:</h3> A total of N=130 patients were identified (mean age: 52.8 years). At initiation of 2L systemic therapy, over 60% of patients had ECOG score of 0 or 1. Cytotoxic monotherapy was the most frequently prescribed regimen (N=60, 46%) in 2L, followed by combination therapies that included platinum doublet chemotherapy, or bevacizumab doublet or triplet combination therapy (N=45, 35%), pembrolizumab monotherapy (N=19, 15%), and bevacizumab monotherapy (N=6, 5%). Majority of patients initiating 2L had prior bevacizumab exposure in 1L (N=81, 62%), mostly as a triplet or doublet combination therapy. Median OS was 9.1 months (95% confidence interval (CI): 7.2-12.2) after initiation of 2L treatment. Median TTD was 2.8 months (95% CI: 2.5, 3.3), and median TFST was 4.9 months (95% CI: 4.2, 5.7). No statistically significant difference in the outcomes were found when stratified by 2L treatments, although sample sizes were small. <h3>Conclusions:</h3> Diverse treatment patterns were observed in the 2L r/mCC setting. Clinical outcomes in these patients were suboptimal and they did not vary significantly by 2L regimen. Additionally, many patients received combination therapies in 2L after having received similar treatments in 1L, even though there is no evidence to support this practice. These findings demonstrate the unmet medical need for new effective treatment options in this setting.