Atezolizumab plus Bevacizumab and Chemotherapy for Metastatic,Persistent,or Recurrent Cervical Cancer(BEATcc):Interpretation of a Randomised,Open-Label,Phase Ⅲ Trial
The GOG240 trial has established bevacizumab with chemotherapy as standard first-line therapy for metastatic or recurrent cervical cancer.In the BEATcc trial,the addition of an immune checkpoint inhibitor to this standard regime was evaluated.In this investigator-initiated,randomized,open-label phase Ⅲ trial,patients were in-cluded from 92 centers in Europe,Japan and the USA.Patients with metastatic(stage Ⅳ B),persistent,or recurrent cervical cancer that was measurable,previously untreated,and not amenable to curative surgery or radiation were randomly assigned 1∶1 to receive standard therapy(cisplatin 50 mg/m2 or carboplatin AUC=5,paclitaxel 175 mg/m2,and bevacizumab 15 mg/kg,all on day 1 of every 3-week cycle)with or without atezolizumab 1 200 mg.Treatment was continued until disease progression,unacceptable toxicity,patient withdrawal,or death.Stratification factors were previous concomitant chemoradiation(yes vs no),histology(squamous cell carcinoma vs adenocarcinoma in-cluding adenosquamous carcinoma),and platinum backbone(cisplatin vs carboplatin).Dual primary endpoints were investigator-assessed progression-free survival according to Response Evaluation Criteria in Solid Tumors version 1.1 and overall survival analyzed in the intention-to-treat population.Between Oct 8,2018,and Aug 20,2021,410 of 519 patients assessed for eligibility were enrolled.Median progression-free survival was 13.7 months(95％CI:2.3～16.6)with atezolizumab and 10.4 months(95％CI:9.7～11.7)with standard therapy(HR=0.62,95％CI:0.49～0.78,P＜0.001).At the interim overall survival analysis,median overall survival was 32.1 months(95％CI:25.3～36.8)versus 22.8 months(95％CI:20.3～28.0),respectively(HR=0.68,95％CI:0.52～0.88,P=0.004 6).Grade 3 or worse adverse events occurred in 79％of patients in the trial group and in 75％of patients in the standard group.Grade 1～2 diarrhoea,arthralgia,pyrexia,and rash were increased with atezolizumab.Adding atezolizumab to a standard bevacizumab plus platinum regimen for metastatic,persistent,or recurrent cervical cancer significantly improves progression-free and overall survival and should be considered as a new first-line therapy option.
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