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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EBevacizumab (BEV) is the first targeted agent that when added to standard chemotherapy improved overall survival (OS) in women with metastatic or relapsed cervical cancer. This finding from a randomized, open-label Phase 3 study represents the first instance in which a targeted therapy has significantly prolonged survival in this setting. This article discusses the The Paclitaxel and Cisplatin or Topotecan With or Without Bevacizumab in Treating Patients With Stage IVB, Recurrent, or Persistent Cervical Cancer study of the Gynecological Oncology Group [GOG 240; \u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00803062\u0026amp;atom=%2Fspmdc%2F13%2F6%2F12.atom\u0022\u003ENCT00803062\u003C\/a\u003E; Tewari KS et al. \u003Cem\u003EJ Clin Oncol\u003C\/em\u003E 2013 (suppl; abstr 3)].\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EOncology Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EReproductive Cancers\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EOncology Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EReproductive Cancers\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EOncology\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EBevacizumab (BEV) is the first targeted agent that when added to standard chemotherapy improved overall survival (OS) in women with metastatic or relapsed cervical cancer. This finding from a randomized, open-label Phase 3 study represents the first instance in which a targeted therapy has significantly prolonged survival in this setting. Results were presented by Krishnansu S. Tewari, MD, University of California Irvine, Irvine, California, USA.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EAcquired drug resistance to platinum-based therapies has rendered these treatments less effective for cervical cancer recurrence, leading to poor outcomes. Tumor neovascularization imparts an aggressive course in cervical cancer, prompting this investigation of an antiangiogenesis therapy targeting the vascular endothelial growth factor A (VEGF-A) in patients with relapsed or advanced disease.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EThe Paclitaxel and Cisplatin or Topotecan With or Without Bevacizumab in Treating Patients With Stage IVB, Recurrent, or Persistent Cervical Cancer study of the Gynecological Oncology Group [GOG 240; \u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00803062\u0026amp;atom=%2Fspmdc%2F13%2F6%2F12.atom\u0022\u003ENCT00803062\u003C\/a\u003E; Tewari KS et al. \u003Cem\u003EJ Clin Oncol\u003C\/em\u003E 2013 (suppl; abstr 3)] included 452 women with recurrent or metastatic cervical cancer who were randomized to 1 of 4 treatment arms using a 2\u00d72 factorial design: 1) treatment with paclitaxel (PAC) 135 or 175 mg\/m\u003Csup\u003E2\u003C\/sup\u003E intravenously (IV) plus cisplatin (CIS) 50 mg\/m\u003Csup\u003E2\u003C\/sup\u003E IV; 2) PAC\/CIS plus BEV 15 mg\/kg IV; 3) PAC 175 mg\/m\u003Csup\u003E2\u003C\/sup\u003E IV plus topotecan (TOPO) 0.75 mg\/m\u003Csup\u003E2\u003C\/sup\u003E on Days 1 to 3; or 4) PAC\/TOPO plus BEV 15 mg\/kg IV. Patients were treated every 21 days until progression, unacceptable toxicity, or complete response. To be eligible, patients had to have measureable disease, a performance status of 0 to 1, and no prior chemotherapy for recurrent disease. The nonplatinum regimen selected was based on laboratory data indicating synergy between TOPO and microtubule-interfering agents and demonstrated activity in recurrent cervical cancer.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EA preplanned interim analysis comparing the platinum doublet and the nonplatinum doublet on median OS showed no significant difference between the chemotherapy-alone groups (median OS, 15 months with PAC\/CIS versus 12.5 months with PAC\/TOPO; one-sided p=0.880).\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EMedian progression-free survival was improved from a mean of 5.9 months with chemotherapy alone to 8.2 months with the addition of BEV. Similarly the response rate was significantly higher with BEV plus chemotherapy compared with chemotherapy alone (48% vs 36%; p=0.0078), with significantly more complete responses in patients treated with anti-VEGF therapy.\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EMedian OS was 17.0 months in BEV-treated patients versus 13.3 months in the arms assigned to chemotherapy alone (HR, 0.71; p=0.0035). Median OS was superior with the addition of BEV to either chemotherapy regimen, although this difference achieved statistical significance when comparing BEV\/CIS\/PAC to CIS\/PAC alone (17.5 vs 14.3 months, respectively; p=0.0348).\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003EThere were four fatal adverse events each with BEV and chemotherapy alone. No new side effects were identified with BEV. Gastrointestinal fistula grade \u22653, a recognized complication of BEV, occurred in 7 (3%) of BEV-treated patients and none of those on chemotherapy alone. Grade \u22652 hypertension was a complication in 54 patients (25%) of the BEV group and 4 (2%) of the group that received chemotherapy alone, but no patient withdrew from the study because of hypertension.\u003C\/p\u003E\u003Cp id=\u0022p-9\u0022\u003EHealth-related quality of life was measured by the Functional Assessment of Cancer Therapy-Cervical Cancer-Trial Outcome Index. The score on this index ranges from 0 to 116 points, with a clinically meaningful change being 4 to 5 points, said Dr. Tewari. Scores on this index were marginally lower, a maximum of 2.95 points and a mean of 1.2 points lower (p=0.3), in the BEV groups compared with the groups that received only chemotherapy, indicating no significant deterioration in quality of life.\u003C\/p\u003E\u003Cp id=\u0022p-10\u0022\u003EBEV represents the first targeted agent that improves the outcome of metastatic or relapsed cervical cancer when added to an established chemotherapy regimen.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2013 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/13\/6\/12.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nznv81\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}