NRG Oncology/RTOG 0921: A phase 2 study of postoperative intensity-modulated radiotherapy with concurrent cisplatin and bevacizumab followed by carboplatin and paclitaxel for patients with endometrial cancer
Akila N Viswanathan, Jennifer Moughan, Brigitte E Miller, Ying Xiao, Anuja Jhingran, Lorraine Portelance, Walter R Bosch, Ursula A Matulonis, Neil S Horowitz, Robert S Mannel, Luis Souhami, Beth A Erickson, Kathryn A Winter, William Small Jr, David K Gaffney, Akila N Viswanathan, Jennifer Moughan, Brigitte E Miller, Ying Xiao, Anuja Jhingran, Lorraine Portelance, Walter R Bosch, Ursula A Matulonis, Neil S Horowitz, Robert S Mannel, Luis Souhami, Beth A Erickson, Kathryn A Winter, William Small Jr, David K Gaffney
Abstract
Background: The current study was conducted to assess acute and late adverse events (AEs), overall survival (OS), pelvic failure, regional failure, distant failure, and disease-free survival in a prospective phase 2 clinical trial of bevacizumab and pelvic intensity-modulated radiotherapy (IMRT) with chemotherapy in patients with high-risk endometrial cancer.
Methods: Patients underwent a hysterectomy and lymph node removal, and had ≥1 of the following high-risk factors: grade 3 carcinoma with >50% myometrial invasion, grade 2 or 3 disease with any cervical stromal invasion, or known extrauterine extension confined to the pelvis. Treatment included pelvic IMRT and concurrent cisplatin on days 1 and 29 of radiation and bevacizumab (at a dose of 5 mg/kg on days 1, 15, and 29 of radiation) followed by adjuvant carboplatin and paclitaxel for 4 cycles. The primary endpoint was grade ≥3 AEs occurring within the first 90 days (toxicity was graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events [version 4.0]).
Results: A total of 34 patients were accrued from November 2009 through December 2011, 30 of whom were eligible and received study treatment. Seven of 30 patients (23.3%; 1-sided 95% confidence interval, 10.6%-36.0%) developed grade ≥3 treatment-related nonhematologic toxicities within 90 days; an additional 6 patients experienced grade ≥3 toxicities between 90 and 365 days after treatment. The 2-year OS rate was 96.7% and the disease-free survival rate was 79.1%. No patient developed a within-field pelvic failure and no patients with International Federation of Gynecology and Obstetrics stage I to IIIA disease developed disease recurrence after a median follow-up of 26 months.
Conclusions: Postoperative bevacizumab added to chemotherapy and pelvic IMRT appears to be well tolerated and results in high OS rates at 2 years for patients with high-risk endometrial carcinoma.
Keywords: bevacizumab; chemotherapy; endometrial cancer; intensity-modulated radiotherapy (IMRT); radiation.
© 2015 American Cancer Society.
Source: PubMed