Objective:

To assess how treatment combinations of platinum choice and bevacizumab use are associated with overall survival (OS) and serious adverse events in patients with advanced cervical cancer (ACC) in clinical settings.

Approach:

• Study Design: A comparative effectiveness analysis using a retrospective cohort from the TriNetX Global Collaborative Network.
• Data Source: TriNetX aggregates deidentified electronic health record data from 143 health care organizations across North America, Europe, and Asia.
• Patient Inclusion Criteria: Adult patients diagnosed with cervical cancer who received first-line systemic treatment for advanced, recurrent, or metastatic ACC with pembrolizumab, paclitaxel, and a platinum agent.
• Patient Exclusion Criteria: Patients with previous diagnoses of breast, kidney, melanoma, lung, or bladder cancer.
• Cohort Comparison: Patients were categorized into two groups based on the platinum agent used: cisplatin (cohort A) and carboplatin (cohort B).

Key Findings:

• The INTERLACE trial showed improved progression-free survival (PFS) and overall survival (OS) with induction chemotherapy followed by chemoradiotherapy.
• The KEYNOTE-826 trial demonstrated that pembrolizumab combined with platinum-based chemotherapy significantly prolonged PFS and OS.
• Exploratory analyses indicated that pembrolizumab improved median OS in patients treated with carboplatin and those who received bevacizumab, but not in those treated with cisplatin.

Interpretation:

The study presents variability in treatment combinations for advanced cervical cancer and highlights the need for further evaluation of platinum agent choice and bevacizumab addition in clinical settings.

Limitations:

• No randomized clinical trials have specifically evaluated the choice of platinum agent or the addition of bevacizumab in combination with immunotherapy for first-line treatment of ACC.
• The study relies on retrospective data, which may introduce biases.

Conclusion:

Further investigation into the effectiveness of different treatment combinations in advanced cervical cancer is warranted.

Sources:

• TriNetX Global Collaborative Network