#VisualAbstract: Atezolizumab in addition to bevacizumab and platinum-based chemotherapy improves survival in metastatic cervical cancer

1. The Atezolizumab group demonstrated significantly greater progression-free and overall survival among patients with metastatic, persistent, or recurrent cervical cancer.

2. Grade 3 or worse adverse events were comparable in both groups.

Evidence Rating Level: 1 (Excellent)

Study Rundown: A previous large-scale trial has shown improved overall survival among patients with cervical cancer treated with bevacizumab and chemotherapy. Other studies have shown similar results using chemotherapy and PD-L1 monoclonal antibodies, such as pembrolizumab. However, the efficacy of all three therapeutic regimens combined is yet to be studied. This phase 3 randomized trial aimed to evaluate the impact of adding atezolizumab to bevacizumab plus chemotherapy on survival in patients with metastatic, recurrent cervical cancer. The primary outcome was progression-free survival, while the key secondary outcome was overall survival. According to study results, atezolizumab significantly improved both progression-free and overall survival compared to the standard regimen. This study was strengthened by a large sample size with patients from various countries, thus augmenting the external validity of the results.

Click to read the study in The Lancet

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In-depth [randomized-controlled trial]: Between Oct 8, 2018, and Aug 20, 2021, 519 patients were screened for eligibility across 92 sites in Europe, Japan, and the USA. Included were patients with metastatic, recurrent cervical cancer (stage IVB), measurable disease, and no curative treatment options. Altogether, 410 patients (206 in the atezolizumab group and 204 in the standard therapy group) were included in the final analysis. The primary outcome of progression-free survival favoured atezolizumab, showing a median of 13.7 months compared to 10.4 months with standard therapy (hazard ratio [HR] 0.62, 95% confidence interval [CI] 0.49-0.78, p<0.0001). Similarly, the secondary outcome of overall survival also demonstrated a significant improvement with atezolizumab, with a median of 32.1 months vs. 22.8 months in the standard group (HR 0.68, 95% CI 0.52-0.88, p<0.046). Overall, findings from this study suggest that adding atezolizumab to bevacizumab plus platinum significantly enhances progression-free and overall survival among patients with metastatic, persistent, or recurrent cervical cancer.

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