OBJECTIVES

Recurrent/metastatic cervical cancer (rmCC) poses a significant clinical burden, particularly among women progressing after first-line therapy. Evidence is limited that second-line or later (2L+) treatment improves outcomes, particularly following treatment with the current first-line standard-of-care, bevacizumab in conjunction with paclitaxel-cisplatin or paclitaxel-topotecan. This systematic literature review investigated the efficacy of 2L+ treatments for rmCC.

METHODS

Systematic searches and study selection were undertaken per a predefined protocol. Eligible studies were prospective studies including >10 patients with squamous cell, adenocarcinoma or adenosquamous histologies receiving 2L+ treatments for rmCC published from 2003-March 2019. Eligible interventions were those recommended by NCCN or ESMO guidelines and outcomes included overall response rate (ORR), overall survival, and progression-free survival.

RESULTS

Among 47,897 records screened, 13 studies met inclusion criteria; all were small, single-arm studies (for all except two studies, n≤35). Only two reported first-line bevacizumab use, one of which led to the accelerated approval of pembrolizumab and reported a 12.2% ORR in the overall population (comprising 84% PD-L1-positive patients). The remaining studies reflected time-frames prior to the approval of bevacizumab in first-line, reported limited efficacy with varying outcome definitions, and most responses were unconfirmed. Two studies investigated 2L+ combination therapies (bevacizumab/atezolizumab, veliparib/topotecan) and reported ORRs of 7-20%, with no complete responses. Eleven 2L+ monotherapy studies were identified, three reporting no responses and only one reporting complete responses. Of studies with partial responses, ORRs were between 4.5-15% (n=7 of 8 studies). One study reported a partial response rate of 29%, but excluded prior taxane use, reflecting a distinct patient population.

CONCLUSIONS

Literature on the outcomes of 2L+ therapy in rmCC is limited and reflected small, single-arm studies, with only one conducted after the approval of bevacizumab in first-line. More data are needed to understand the place in therapy of current 2L+ regimens.