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DOI: 10.1055/a-2520-5736
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 UterusEvaluierung der Grundmerkmale und therapeutischen Managementstrategien beim metastatischen Gebärmutterhalskrebs in Deutschland: eine multizentrische longitudinale BeobachtungsstudieEine Qualitätssicherungsinitiative der AGO und der AGO-OK UterusSupported by: AGO Studiengruppe
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.
Zusammenfassung
Einleitung
Es fehlt an Real-World-Daten zu den Behandlungsmustern und -ergebnissen beim rezidivierenden und metastatischen Gebärmutterhalskrebs (r/mCC) in Deutschland.
Methoden
Diese erste nationale Qualitätssicherungsinitiative besteht aus einer retrospektiven Analyse von Patientinnen mit r/mCC, die zwischen 2018 und 2022 diagnostiziert wurden. Die Patientinnen wurden in den Krankenakten von 31 gynäkologischen Krebszentren in Deutschland identifiziert. Die demografischen und klinischen Merkmale der Patientinnen sowie die Behandlungsmuster und klinischen Ergebnisse wurden deskriptiv evaluiert. Progressionsfreies Überleben (PFÜ) und Gesamtüberleben (GÜ) wurden mithilfe der Kaplan-Meier-Method berechnet.
Ergebnisse
Insgesamt wurden 503 geeignete Patientinnen (Durchschnittsalter 55 Jahre) in Bezug auf r/mCC analysiert. 276/503 der Patientinnen (55%) erhielten eine Primärtherapie (1L) bestehend aus einer Chemotherapie (Platin-Kombinationstherapie: 247/276; 79%), gefolgt von einer gezielten Antikörpertherapie mit Bevacizumab (177/247; 72%), einer Immuntherapie (19/247; 8%) oder eine Kombination von beiden (50/247; 20%). 111/503 (22%) erhielten Chemotherapie allein (Platin-Kombinationstherapie: 64/111, 58%; Monotherapie mit Platin: 35/111, 31%; oder platinfreie Monotherapie: 12/111; 11%). 110/503 (22%) erhielten keine systemische Therapie (die verbleibenden 6/503 Patientinnen erhielten nur eine Immuntherapie). Nach einer durchschnittlichen Nachbeobachtungszeit von 16 Monaten betrug das PFÜ für diese Untergruppen 12 Monate (95%-KI 11–14), 8,8 Monate (95%-KI 7,1–11) resp. 3 Monate (95%-KI 2,3–4,8), und das GÜ betrug 25 Monate (95%-KI 21–31), 17 Monate (95%-KI 14–22) resp. 3,6 Monate (95%-KI 2,8–5,3). 176/283 (62%) der Patientinnen mit progredienter Erkrankung (PE) erhielten eine Second-Line-(2L-)Therapie.
Schlussfolgerung
Nur die Hälfte der Patientinnen mit r/mCC erhielten eine First-Line-Platin-Kombinationstherapie einschließlich Antikörpertherapie gemäß den nationalen Richtlinien. Dazu kommt noch, dass 22% der Patientinnen bei der Erstdiagnose und 38% der Patientinnen mit PE überhaupt keine systemische Therapie erhielten. Dies könnte die Folge eines generell schwachen Leistungstandes sein oder aber es spiegelt die Präferenzen der Patientinnen und/oder den Mangel an wirksamen Therapien wider, besonders in Hinblick auf 2L-Therapien.
Publication History
Received: 19 December 2024
Accepted: 12 January 2025
Article published online:
15 May 2025
© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).
Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany
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