Development of a platform for systemic antiangiogenesis therapy for advanced cervical cancer

Women with metastatic, recurrent, or persistent cervical carcinoma historically have had extremely limited treatment options. Systemic chemotherapy in these settings is predominantly palliative and has been associated with platinum resistance, nondurable responses, rapid progression of disease with deterioration in quality of life, and early death. At the cooperative group level, efforts to breach this clinical impasse have focused on incorporation of antiangiogenesis therapy, medical optimization, and identification of less toxic regimens. Gynecologic Oncology Group protocols 204 and 240, along with the Japanese Clinical Oncology Group protocol 0505, make up the pivotal phase 3 clinical trials that have provided 3 distinct treatment options. These options incorporate the antiangiogenesis humanized monoclonal antibody bevacizumab in combination with either a platinum-based or nonplatinum-based chemotherapy doublet. This review will highlight the development of bevacizumab in advanced cervical cancer and address the relevance of the survival gain obtained using antiangiogenesis therapy in this high-risk population.