Combination therapy with topotecan, paclitaxel, and bevacizumab improves progression-free survival in recurrent small cell neuroendocrine carcinoma of the cervix

Abstract

Objectives To assess if the combination of topotecan, paclitaxel, and bevacizumab (TPB) was active in recurrent SCCC and to compare the survival of patients with SCCC who received TPB to a group of women with SCCC who did not receive this regimen. Methods We retrospectively analyzed women with recurrent SCCC who received chemotherapy as primary therapy. Women treated with TPB for first recurrence were compared to women treated with non-TPB chemotherapy. Results Thirteen patients received TPB, and 21 received non-TPB chemotherapy, most commonly platinum with or without a taxane. Median progression-free survival (PFS) was 7.8 months for TPB and 4.0 months for non-TPB regimens (hazard ratio [HR] 0.21, 95% CI 0.09–0.54, P=0.001). Median overall survival (OS) was 9.7 months for TPB and 9.4 months for non-TPB regimens (HR 0.53, 95% CI 0.23–1.22, P=0.13). Eight women (62%) who received TPB versus four (19%) who received non-TPB regimens were on treatment for >6 months (P=0.02), and four patients (31%) in the TPB group versus two (10%) in the non-TPB group were on treatment for >12 months (P=0.17). In the TPB group, three patients (23%) had complete response, two (15%) had complete response outside the brain with progression in the brain, 3 (23%) had a partial response, 2 (15%) had stable disease, and 3 (23%) had progressive disease. Conclusions These findings indicate that TPB for recurrent SCCC significantly improved PFS over non-TPB regimens, and trends towards improved OS. Furthermore, a significant number of patients had a durable clinical benefit.

Neuroendocrine carcinoma of the cervix: a systematic review of the literature

“…The largest series of women analyzing the treatment efficacy of chemotherapy among women with recurrent NECC was published by Frumovitz et al [ 140 ]. They compared 13 patients who received the combination of topotecan, paclitaxel, and bevacizumab (TPB) with 21 patients receiving other regimens, mostly a platinum-based regimen with or without a taxane.…”

Influence of clinicopathological characteristics and comprehensive treatment models on the prognosis of small cell carcinoma of the cervix: A systematic review and meta-analysis

“…Li et al[ 33 ] found that patients who underwent NACT plus radical surgery had a lower rate of distant recurrence compared with those who underwent radical surgery alone (P = 0.029), and deduced that although platinum-based NACT cannot improve the survival rate of SCCC, it can control distant recurrence[ 34 ]. In a retrospective analysis of 13 patients with SCCC receiving a TPB regimen (topotecan, paclitaxel, and bevacizumab) and 21 patients who did not receive TPB conducted by Frumovitz et al[ 35 ], it was found that the median progression-free survival was 7.8 months in the TPB group and 4.0 months in the non-TPB group (P = 0.001), suggesting that a TPB regimen improves survival. Although very few studies on NACT were included in this study, the results show that NACT is closely associated with prognosis.…”

Updates and management algorithm for neuroendocrine tumors of the uterine cervix

“…Our regimen of choice for patients with recurrent or progressive disease who have already been treated with a platinum and etoposide combination is a triplet regimen including topotecan, paclitaxel, and bevacizumab given in the same manner as in Gynecologic Oncology Group (GOG) 240, a phase III study in patients with recurrent cervical cancer (squamous cell carcinoma, adenocarcinoma, and adenosquamous carcinoma) 58. The rationale for this schema is that first this regimen is tolerable in women who have previously undergone definitive chemoradiation.…”