On August 14, 2014, the FDA approved the angiogenesis inhibitor bevacizumab (Avastin) for the treatment of advanced cervical cancer.

On August 14, the FDA approved the angiogenesis inhibitor bevacizumab (Avastin; Genentech) to treat recurrent or metastatic cervical cancer. The approval represents the first meaningful clinical advance for treating the disease since 2004, when platinum-based chemotherapy combinations, such as cisplatin and paclitaxel, were found to be more active than single-agent cisplatin.

Bevacizumab is also approved for the treatment of colorectal cancer, glioblastoma, non–small cell lung cancer, and renal cell carcinoma.

The FDA based its approval on results from a randomized phase III trial showing that the addition of bevacizumab to chemotherapy extended median overall survival from 13 to 17 months (N Engl J Med 2014;370:734–43). Chemotherapy alone typically results in median survival of 7 to 12 months. Bevacizumab is the first targeted therapy to extend survival.

“With bevacizumab, not only did patients live longer but they lived longer without any significant deterioration in quality of life,” says Krishnansu Tewari, MD, professor and director of research in the Division of Gynecologic Oncology at the University of California, Irvine, and principal investigator of the phase III study. Hinting at new research possibilities, he adds, “That may present a window of opportunity to offer additional treatment to patients who are responding to bevacizumab and possibly extend their lives further.”

Researchers could use that window to test the effectiveness of new molecular therapies and immunotherapy, says Tewari. For example, pazopanib, an intracellular small-molecule tyrosine kinase inhibitor that targets VEGF receptor, and sorafenib, a multikinase inhibitor, have shown promise in treating advanced cervical cancer.

Future studies will focus on how to identify the patients most likely to respond to bevacizumab, says Tewari. He is working with researchers in the UK who identified a proangiogenic signature in ovarian cancer associated with improved progression-free survival to see if that signature is also present in cervical cancer.

“If we can find a group of patients who are expressing those angiogenic proteins and show that those patients are the ones most likely to respond to bevacizumab,” says Tewari, “it will be a very big step forward in terms of personalized delivery of medicine.”

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