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Bevacizumab Fistula Cervix — SCE Medical Oncology MCQ

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HardGynaecological CancersBevacizumab Fistula CervixSCE Medical Oncology

A 50-year-old woman with metastatic cervical cancer (PD-L1 CPS ≥1) on pembrolizumab + chemotherapy ± bevacizumab achieves a partial response. She develops a fistula (vesicovaginal). What is the concern regarding bevacizumab in cervical cancer?

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Correct answer: A — Bevacizumab increases fistula risk in cervical cancer (~5-10%) due to anti-VEGF effects on irradiated/tumour-infiltrated tissue — this is higher than in other tumour types and requires careful patient selection

Bevacizumab in cervical cancer carries an elevated fistula risk (~5-10%) compared with other tumour types (~1-2%). This is due to the combination of anti-VEGF effects impairing tissue healing in pelvic tissue that may be previously irradiated and/or infiltrated by tumour adjacent to the bladder/rectum. The GOG-240 trial confirmed OS benefit of bevacizumab in cervical cancer despite this risk. Patient selection (avoiding bevacizumab in patients with tumour abutting/invading bladder or rectum) is important.

Reference: ESMO 2024 Cervical Cancer; GOG-240 Tewari et al NEJM 2014; KEYNOTE-826