Real-world treatment pattern and drop-off among recurrent or metastatic cervical cancer patients: A US community oncology-based analysis (304)

Abstract

Objectives: Recurrent or metastatic cervical cancer (r/mCC) treatment pattern and data on subsequent therapy utilization following first-line (1L) are limited. Additionally, there is no current real-world data on the proportion of eligible second-line (2L) patients who received treatment following progression on chemotherapy doublet +/- bevacizumab. These data are needed to inform clinical trials and treatment algorithms as new therapies become available for the r/mCC patient population, which historically has had poor outcomes characterized by poor overall survival under conventional treatments. Methods: An observational study was conducted among women with r/mCC who initiated 1L systemic therapy within the US Oncology Network (USON) between September 2014 and December 2019, with follow-up through December 2020. USON’s electronic health record was used to identify eligible patients and abstract data. Patient clinical characteristics, treatment pattern, the proportion of patients receiving 2L therapy, and duration of 1L treatment were evaluated. Results: A total of 262 r/mCC patients were identified (mean age: 53 years). Over half of patients (n=143, 55%) had an ECOG performance status score of ≤1, with most patients (72%) having undergone prior radiation or surgery, and histology subgroups generally represented reflective of that reported in the literature for cervical malignancy. Most patients received chemotherapy doublet + bevacizumab (n=174, 66%) or chemotherapy doublet alone (n=62, 24%) as their 1L systemic therapy. The median treatment duration was 4.1 months (0.03-38.4 months). A total of 125 patients (48%) received 2L therapy. In 2L, there was no clear treatment of choice, including cytotoxic monotherapy (n=40), combination therapy (n=39), and pembrolizumab monotherapy (n=35). Of note, a substantial number of patients discontinued 1L for any reason but did not receive 2L treatment, including those progressing on 1L (n=31, 12%), and after discontinuing 1L for other reasons (n=23, 9%). Conclusions: In this real-world retrospective observational study, most patients received the current standard of care systemic therapy in the 1L for treatment of r/mCC. However, less than half of patients received subsequent treatment after completing 1L. Of the patients who received 2L therapy, there was no single clear choice of therapy for patients. As novel and more effective therapies become available, more r/mCC patients needing subsequent treatment may benefit from these emerging options. Objectives: Recurrent or metastatic cervical cancer (r/mCC) treatment pattern and data on subsequent therapy utilization following first-line (1L) are limited. Additionally, there is no current real-world data on the proportion of eligible second-line (2L) patients who received treatment following progression on chemotherapy doublet +/- bevacizumab. These data are needed to inform clinical trials and treatment algorithms as new therapies become available for the r/mCC patient population, which historically has had poor outcomes characterized by poor overall survival under conventional treatments. Methods: An observational study was conducted among women with r/mCC who initiated 1L systemic therapy within the US Oncology Network (USON) between September 2014 and December 2019, with follow-up through December 2020. USON’s electronic health record was used to identify eligible patients and abstract data. Patient clinical characteristics, treatment pattern, the proportion of patients receiving 2L therapy, and duration of 1L treatment were evaluated. Results: A total of 262 r/mCC patients were identified (mean age: 53 years). Over half of patients (n=143, 55%) had an ECOG performance status score of ≤1, with most patients (72%) having undergone prior radiation or surgery, and histology subgroups generally represented reflective of that reported in the literature for cervical malignancy. Most patients received chemotherapy doublet + bevacizumab (n=174, 66%) or chemotherapy doublet alone (n=62, 24%) as their 1L systemic therapy. The median treatment duration was 4.1 months (0.03-38.4 months). A total of 125 patients (48%) received 2L therapy. In 2L, there was no clear treatment of choice, including cytotoxic monotherapy (n=40), combination therapy (n=39), and pembrolizumab monotherapy (n=35). Of note, a substantial number of patients discontinued 1L for any reason but did not receive 2L treatment, including those progressing on 1L (n=31, 12%), and after discontinuing 1L for other reasons (n=23, 9%). Conclusions: In this real-world retrospective observational study, most patients received the current standard of care systemic therapy in the 1L for treatment of r/mCC. However, less than half of patients received subsequent treatment after completing 1L. Of the patients who received 2L therapy, there was no single clear choice of therapy for patients. As novel and more effective therapies become available, more r/mCC patients needing subsequent treatment may benefit from these emerging options.