Immuno-Molecular Targeted Therapy Use and Survival Benefit in Patients with Stage IVB Cervical Carcinoma in Commission on Cancer®-Accredited Facilities in the United States

Collin A Sitler; Chunqiao Tian; Chad A Hamilton; Michael T Richardson; John K Chan; Daniel S Kapp; Charles A Leath 3rd; Yovanni Casablanca; Christina Washington; Nicole P Chappell; Ann H Klopp; Craig D Shriver; Christopher M Tarney; Nicholas W Bateman; Thomas P Conrads; George Larry Maxwell; Neil T Phippen; Kathleen M Darcy

doi:10.3390/cancers16051071

Immuno-Molecular Targeted Therapy Use and Survival Benefit in Patients with Stage IVB Cervical Carcinoma in Commission on Cancer^®-Accredited Facilities in the United States

Cancers (Basel). 2024 Mar 6;16(5):1071. doi: 10.3390/cancers16051071.

Authors

Collin A Sitler^{1

2}, Chunqiao Tian^{1

2

3}, Chad A Hamilton⁴, Michael T Richardson⁵, John K Chan⁶, Daniel S Kapp⁷, Charles A Leath 3rd⁸, Yovanni Casablanca⁹, Christina Washington¹⁰, Nicole P Chappell¹¹, Ann H Klopp¹², Craig D Shriver², Christopher M Tarney^{1

2}, Nicholas W Bateman^{1

2

3}, Thomas P Conrads^{1

2

13}, George Larry Maxwell^{1

2

13}, Neil T Phippen^{1

2}, Kathleen M Darcy^{1

2

3}

Affiliations

¹ Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA.
² Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA.
³ The Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Bethesda, MD 20817, USA.
⁴ Gynecologic Oncology Section, Women's Services and The Ochsner Cancer Institute, Ochsner Health, New Orleans, LA 70115, USA.
⁵ Department of Obstetrics and Gynecology, Los Angeles School of Medicine, University of California, Los Angeles, CA 90024, USA.
⁶ Palo Alto Medical Foundation, California Pacific Medical Center, Sutter Health, San Francisco, CA 94010, USA.
⁷ Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA.
⁸ Division of Gynecologic Oncology, University of Alabama at Birmingham, O'Neal Comprehensive Cancer Center, Birmingham, AL 35249, USA.
⁹ Gynecologic Oncology Division, Levine Cancer Institute, Atrium Health, Charlotte, NC 28204, USA.
¹⁰ Gynecologic Oncology Division, Stephenson Cancer Center, Oklahoma University Health Sciences Center, Oklahoma City, OK 73104, USA.
¹¹ Gynecologic Oncology Division, GW Medical Faculty Associates, George Washington University, Washington, DC 20037, USA.
¹² Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
¹³ Women's Health Integrated Research Center, Women's Service Line, Inova Health System, Falls Church, VA 22042, USA.

Abstract

Purpose: To investigate IMT use and survival in real-world stage IVB cervical cancer patients outside randomized clinical trials.

Methods: Patients diagnosed with stage IVB cervical cancer during 2013-2019 in the National Cancer Database and treated with chemotherapy (CT) ± external beam radiation (EBRT) ± intracavitary brachytherapy (ICBT) ± IMT were studied. The adjusted hazard ratio (AHR) and 95% confidence interval (CI) for risk of death were estimated in patients treated with vs. without IMT after applying propensity score analysis to balance the clinical covariates.

Results: There were 3164 evaluable patients, including 969 (31%) who were treated with IMT. The use of IMT increased from 11% in 2013 to 46% in 2019. Age, insurance, facility type, sites of distant metastasis, and type of first-line treatment were independently associated with using IMT. In propensity-score-balanced patients, the median survival was 18.6 vs. 13.1 months for with vs. without IMT (p < 0.001). The AHR was 0.72 (95% CI = 0.64-0.80) for adding IMT overall, 0.72 for IMT + CT, 0.66 for IMT + CT + EBRT, and 0.69 for IMT + CT + EBRT + ICBT. IMT-associated survival improvements were suggested in all subgroups by age, race/ethnicity, comorbidity score, facility type, tumor grade, tumor size, and site of metastasis.

Conclusions: IMT was associated with a consistent survival benefit in real-world patients with stage IVB cervical cancer.

Keywords: cervical cancer; chemotherapy; external beam radiation; first-line treatment; immunotherapy; intracavitary brachytherapy; radiation; stage IVB; survival; targeted therapy.

Grants and funding

HU0001-19-2-0031, HU0001-20-2-0033, HU0001-21-2-0027, HU0001-22-2-0016, HU0001-23-2-0038 and HU0001-18-2-0032/Uniformed Services University of the Health Sciences