Some cervical cancer patients with advanced or recurrent disease suffer from anaphylaxis after taxane- or platinum-based therapy, and there is no standard treatment for progressive disease that develops during or shortly after platinum-based chemotherapy. Doctors and patients have therefore sought the development of a non-taxane, non-platinum regimen for recurrent cervical cancer.
Platinum-based chemotherapy is considered the standard treatment for advanced or recurrent cervical cancer, and a combination regimen of paclitaxel, platinum, and bevacizumab (Avastin and its FDA-approved biosimilar Mvasi, is widely recognized as the standard treatment. But some cervical cancer patients with advanced or recurrent disease suffer from anaphylaxis after taxane- or platinum-based therapy, and there is no standard treatment for progressive disease that develops during or shortly after platinum-based chemotherapy. Doctors and patients have therefore sought the development of a non-taxane, non-platinum regimen for recurrent cervical cancer.
A recent Japanese case report of 4 women with recurrent cervical cancer, published in Gynecologic Oncology Reports, suggests that bevacizumab with metronomic chemotherapy (treatment in which low doses of anticancer drugs are given on a continuous or frequent, regular schedule such as daily or weekly, usually over a long period of time) of low-dose oral cyclophosphamide (CFA) should be considered for second-line chemotherapy.
The study, by Rose Isono-Nakata, MD, and colleagues, treated 4 patients with recurrent cervical cancer using a regimen of 50 mg of oral CFA daily and 15 mg/kg of bevacizumab (BEV) repeated every 3 weeks (CFA-BEV). The 4 patients followed in the report had no cancer-associated symptoms prior to the initiation of CFA-BEV therapy. The researchers therefore considered metronomic chemotherapy with bevacizumab because it could potentially prolong tumor stabilization with mild toxicity rather than the rapid and short-term regression responses caused by standard MTD therapy.
The researchers report that 1 patient had disease progression after 4 months, but the other 3 continued the regimen until their last follow-up at 13, 14, and 15 months, respectively. One patient suffered from grade 3 neutropenia; however, no grade 2 or higher non-hematological toxicities were observed.
Among the 3 patients who received salvage chemotherapy, 1 had a progression-free survival (PFS) of 4.2 months and the other 2 continued treatment for more than 13 months without disease progression. One patient continued the regimen as maintenance chemotherapy for more than 13 months after radiotherapy for metastases in the pubic region and surrounding soft tissues.
The researchers conclude that CFA-BEV could be a promising potential treatment for patients who experience recurrent disease shortly after platinum treatment, anaphylaxis in response to paclitaxel or platinum, or peripheral neuropathy.
“These cases demonstrate the use of CFA-BEV with minimal toxicity and expected anti-cancer activity and indicate that this regimen should be considered for second-line chemotherapy in advanced recurrent cervical cancer,” they noted. “In addition, the application of this therapy regimen to asymptomatic patients with minor or dormant recurrent disease should be further investigated.”
Reference
Isono-Nakata R, Tsubamoto H, Ueda T, Inoue K, Shibahara H. Bevacizumab with metronomic chemotherapy of low-dose oral cyclophosphamide in recurrent cervical cancer: four cases. Gynecol Oncol Rep. 2018 April 6;24:57-60. doi: 10.1016/j.gore.2018.04.001.
AON Saves Over $243 Million With High Biosimilar Adoption
April 22nd 2024Thanks to high biosimilar adoption rates within the community oncology setting, American Oncology Network (AON) saved upwards of $243 million between 2020 and 2023, according to a presentation at the Festival of Biologics USA conference in San Diego, California.
A New Chapter: How 2023 Will Shape the US Biosimilar Space for 2024 and Beyond
December 31st 2023On this episode of Not So Different, Cencora's Brian Biehn and Corey Ford take a look back at major policy and regulatory advancements in 2023 and how these changes will alter the space going forward.
Global Biosimilar Market Projected to Reach $1.3 Trillion by 2032
April 11th 2024The global biosimilar market is projected to surge from $25.1 billion in 2022 to approximately $1.3 trillion by 2032, with a compound annual growth rate of 17.6%, driven mainly by the increasing prevalence of cancer and the cost-effectiveness of biosimilars, as outlined in a report by Towards Healthcare.
Study: More Biosimilar Competition Is Not Lowering Patient OOP Costs
March 29th 2024Despite more biosimilars entering the market and generating significant savings for payers and health care systems, these savings are not resulting in lower out-of-pocket (OOP) costs for patients, according to a recent study.
Physician and Patient Perspectives After Starting or Switching to Amgevita in IBD
March 23rd 2024A real-world study surveying physicians and patients on adalimumab biosimilar ABP 501 (Amgevita) in inflammatory bowel disease (IBD) found both patients initiating ABP 501 and those who had switched from the reference product had higher satisfaction levels.