Evaluation of Baseline Characteristics and Therapeutic Management Strategies in Metastatic Cervical Cancer in Germany: A Multicentric Retrospective Longitudinal Observational Study: A Quality Assurance Initiative of the AGO-Study Group and AGO-OK Uterus.
Dominik Denschlag, Bastian Czogalla, Florian Heitz, Markus Kerkmann, Laura-Christin Fangmann, Philip H Klecker, Frederik A Stuebs, Linn Wölber, Julia Radosa, Pia C Lodde, Stephan Seitz, Christian George, Pawel Mach, Angelina Fink, Davit Bokhua, Nikolaus deGregorio, Björn Lampe, Franziska Hemptenmacher, Verena Friebe, Markus Fleisch, Pauline Wimberger, Anna Jaeger, Andreas Schnelzer, Suzana Mittelstadt, Dominik Ratiu, Michael Eichbaum, Adriana Haus, Matthias Kalder, Beyhan Ataseven, Willibald Schröder, Holger Bronger, Jens Kosse, Uwe Andreas Ulrich, Gabriele Elser, Philipp Harter
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Abstract
Introduction: Real-world data on treatment patterns and outcomes in recurrent or metastatic cervical cancer (r/mCC) are lacking.
Methods: This first national quality assurance initiative was a retrospective analysis of patients with r/mCC diagnosed between 2018 and 2022, who were identified from medical records of 31 gynecologic cancer centers in Germany. Patient demographic and clinical characteristics, treatment patterns, and clinical outcomes were assessed descriptively. Progression-free (PFS) and overall survival (OS) were calculated using Kaplan-Meier analysis.
Results: A total of 503 eligible patients (median age 55 years) were analyzed for r/mCC. 276/503 patients (55%) received first-line (1L) chemotherapy (platinum combination: 247/276; 79%) followed by targeted antibody therapy with bevacizumab (177/247; 72%), immunotherapy (19/247; 8%), or both combined (50/247; 20%). 111/503 (22%) received chemotherapy only (platinum combination: 64/111; 58%, platinum mono: 35/111; 31%, or platinum-free: 12/111; 11%), and 110/503 (22%) did not receive any systemic treatment (the remaining 6/503 patients received immunotherapy only). For these subgroups after a median follow-up of 16 months, the PFS was 12 months (95% CI 11-14), 8.8 months (95% CI 7.1-11), and 3 months (95% CI 2.3-4.8), and OS was 25 months (95% CI 21-31), 17 months (95% CI 14-22), and 3.6 months (95% CI 2.8-5.3), respectively. 176/283 (62%) patients who developed progressive disease (PD) were treated with second-line (2L) therapy.
Conclusion: Only half of the patients with r/mCC were treated 1L with platinum-combination therapy including antibody therapy according to national guidelines. Moreover, 22% at initial diagnosis and 38% of patients at PD were not treated with systemic therapy at all. This might reflect poor general performance status, patients' preference, and/or lack of effective therapies especially in 2L treatment.
关于复发或转移性宫颈癌（r/mCC）的治疗模式和结果的实际数据缺乏。方法：这是第一个国家质量保证计划，对2018年至2022年间诊断为r/mCC的患者进行回顾性分析，这些患者来自德国31个妇科癌症中心的医疗记录。对患者人口统计学和临床特征、治疗模式和临床结果进行描述性评估。采用Kaplan-Meier分析计算无进展（PFS）和总生存期（OS）。结果：共有503例符合条件的患者（中位年龄55岁）被分析为r/mCC。276/503例患者（55%）接受一线（1L）化疗(铂类联合化疗：247/276；79%)，其次是贝伐单抗靶向抗体治疗(177/247；72%)，免疫治疗(19/247；8%)，或者两者兼而有之(50/247；20%)。111/503（22%）仅接受化疗(铂类联合化疗：64/111；58%，单铂：35/111；31%，或无铂：12/111；11%), 110/503（22%）患者未接受任何全身治疗（其余6/503患者仅接受免疫治疗）。在这些亚组中位随访16个月后，PFS分别为12个月（95% CI 11-14）、8.8个月（95% CI 7.1-11）和3个月（95% CI 2.3-4.8）， OS分别为25个月（95% CI 21-31）、17个月（95% CI 14-22）和3.6个月（95% CI 2.8-5.3）。176/283（62%）进展性疾病（PD）患者接受了二线（2L）治疗。结论：只有一半的r/mCC患者按照国家指南接受含抗体治疗的铂联合治疗。此外，22%的初始诊断患者和38%的PD患者根本没有接受过全身治疗。这可能反映了总体表现不佳、患者偏好和/或缺乏有效的治疗方法，特别是在2L治疗中。
期刊介绍：
Geburtshilfe und Frauenheilkunde (GebFra) addresses the whole field of obstetrics and gynecology and is concerned with research as much as with clinical practice. In its scientific section, it publishes original articles, reviews and case reports in all fields of the discipline, namely
gynecological oncology, including oncology of the breast
obstetrics and perinatal medicine,
reproductive medicine,
and urogynecology.
GebFra invites the submission of original articles and review articles.
In addition, the journal publishes guidelines, statements and recommendations in cooperation with the DGGG, SGGG, OEGGG and the Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF, Association of Scientific Medical Societies, www.awmf.org). Apart from the scientific section, Geburtshilfe und Frauenheilkunde has a news and views section that also includes discussions, book reviews and professional information.
Letters to the editors are welcome. If a letter discusses an article that has been published in our journal, the corresponding author of the article will be informed and invited to comment on the letter. The comment will be published along with the letter.
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