Retrospective study of bevacizumab use and platinum choice in pembrolizumab-treated advanced cervical cancer

Pembrolizumab plus chemotherapy, with or without bevacizumab improves overall survival (OS) in advanced cervical cancer (aCC), but platinum choice and bevacizumab use remain discretionary. A comparative effectiveness study, using a retrospective multinational cohort with propensity score matching in theTriNetX Global Collaborative Network, compared OS by platinum agent (cisplatin or carboplatin) and bevacizumab use among patients with aCC receiving first-line pembrolizumab plus paclitaxel. The study included 1931 patients. Two comparisons were analyzed: cisplatin versus carboplatin (623 patient pairs), and bevacizumab versus no bevacizumab (455 pairs). Cisplatin and carboplatin showed equivalent OS: 25.1 months in both groups (p=0.35). Bevacizumab addition was associated with an early survival benefit: 12-month OS rate was 74.8% (95% CI 70.4-79.2) with bevacizumab versus 64.5% (59.8-69.2) without bevacizumab; 24-month OS rate was 56.2% (50.9-61.5) versus 54.0% (48.7-59.3), respectively. No increased risk of fistula (p=0.76), bowel perforation (p=0.67), or pulmonary embolism (p=0.052) was observed. The authors conclude that among patients with aCC, cisplatin and carboplatin treatment were associated with similar effectivenes when combined with first-line pembrolizumab plus paclitaxel, whereas addition of bevacizumab was associated with early OS benefit, which attenuated over time.