Prospective validation of pooled prognostic factors in women with advanced cervical cancer treated with chemotherapy with/without bevacizumab: NRG Oncology/GOG study

Krishnansu S. Tewari, Michael W. Sill, Bradley J. Monk, Richard T. Penson, Harry J. Long, Andrés Poveda, Lisa M. Landrum, Mario M. Leitao, Jubilee Brown, Thomas J.A. Reid, Helen E. Michael, David H. Moore

Research output: Contribution to journalArticle

36 Scopus citations

Abstract

Purpose: In the randomized phase III trial, Gynecologic Oncology Group (GOG) protocol 240, the incorporation of bevacizumab with chemotherapy significantly increased overall survival (OS) in women with advanced cervical cancer. A major objective of GOG-240 was to prospectively analyze previously identified pooled clinical prognostic factors known as the Moore criteria. Experimental Design: Potential negative factors included black race, performance status 1, pelvic disease, prior cisplatin, and progression-free interval <365 days. Risk categories included low-risk (0-1 factor), mid-risk (2-3 factors), and high-risk (4-5 factors). Each test of association was conducted at the 5% level of significance. Logistic regression and survival analysis was used to determine whether factors were prognostic or could be used to guide therapy. Results: For the entire population (n = 452), high-risk patients had significantly worse OS (P < 0.0001). The HRs of death for treating with topotecan in low-risk, mid-risk, and high-risk subsets are 1.18 [95% confidence interval (CI), 0.63-2.24], 1.11 (95% CI, 0.82-1.5), and 0.84 (95% CI, 0.50-1.42), respectively. The HRs of death for treating with bevacizumab in low-risk, mid-risk, and high-risk subsets are 0.96 (95% CI, 0.51-1.83; P = 0.9087), 0.673 (95% CI, 0.5-0.91; P = 0.0094), and 0.536 (95% CI, 0.32-0.905; P = 0.0196), respectively. Conclusions: This is the first prospectively validated scoring system in cervical cancer. The Moore criteria have real-world clinical applicability. Toxicity concerns may justify omission of bevacizumab in some low-risk patients where survival benefit is small. The benefit to receiving bevacizumab appears to be greatest in the moderate- and high-risk subgroups (5.8-month increase in median OS).

Original languageEnglish (US)
Pages (from-to)5480-5487
Number of pages8
JournalClinical Cancer Research
Volume21
Issue number24
DOIs
StatePublished - Dec 15 2015

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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    Tewari, K. S., Sill, M. W., Monk, B. J., Penson, R. T., Long, H. J., Poveda, A., Landrum, L. M., Leitao, M. M., Brown, J., Reid, T. J. A., Michael, H. E., & Moore, D. H. (2015). Prospective validation of pooled prognostic factors in women with advanced cervical cancer treated with chemotherapy with/without bevacizumab: NRG Oncology/GOG study. Clinical Cancer Research, 21(24), 5480-5487. https://doi.org/10.1158/1078-0432.CCR-15-1346