Gynecologic Cancers: Case 2 - Episode 9

Krishnansu S. Tewari, MD, FACOG, FACS: Adding Bevacizumab to Cisplatin/Paclitaxel in Patient

In GOG 240, the cisplatin-paclitaxel-bevacizumab triplet was studied as first-line therapy for recurrent disease and resulted in a significant improvement in OS. In this case, when the patient was diagnosed with recurrent disease, she was treated with cisplatin-paclitaxel as first-line therapy and now has progressed. Therefore, I would not add bevacizumab to cisplatin-paclitaxel and would recommend that the patient participate in a clinical trial involving either antiangiogenesis therapy or immunotherapy. In the absence of such trials, I would consider treating the patient with single-agent bevacizumab alone at 15 mg/kg as second-line therapy, based on results from the GOG 227C phase II trial.

CASE 2: Cervical Cancer

Stephanie M. is a 48-year-old Caucasian mother of 2 children who works as a dental hygienist.

She presented to her PCP in May 2012 with vaginal discharge and pain during intercourse. Prior medical history was notable for smoking (quit 3 years ago) and well-controlled hypertension. Patient had completed only sporadic cervical screening for the past 10 years.

  • Subsequent Pap smear showed the presence of squamous intraepithelial lesions and HPV-16 positivity
  • She was referred to oncologist for further evaluation. Ultrasound and colposcopy showed the presence of a 3.0-cm lesion in cervix with extension into the vagina. Patient was diagnosed with squamous cell carcinoma FIGO stage 1B1
  • Patient underwent radical hysterectomy with pelvic lymphadenectomy, with 3 positive pelvic nodes
  • She received pelvic radiotherapy with concurrent weekly cisplatin
  • Patient remained disease free for approximately 2 years

In September 2014, she presented with worsening abdominal pain and fatigue. CT scan showed diffuse pelvic and aortic adenopathy consistent with disease recurrence. Her renal and hepatic function were adequate.

  • Patient received treatment with cisplatin/paclitaxel for metastatic disease
  • After 3 cycles, patient presents with worsening pain and CT evidence of disease progression