Open Access

ARTICLE

Endostar, an Antiangiogenesis Inhibitor, Combined With Chemoradiotherapy for Locally Advanced Cervical Cancer

Heming Lu^*†1, Yuying Wu^‡1, Xu Liu^†, Huixian Huang^†, Hailan Jiang^†, Chaohua Zhu^†, Yuping Man^§, Zhaohong Chen^†, Xianfeng Long^†, Qiang Pang^†, Luxing Peng^†, Xianglong Li^†, Junzhao Gu^†, Shan Deng^†, Ligang Xing^*

* Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, P.R. China
† Department of Radiation Oncology, People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, P.R. China
‡ Department of Gynecology, People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, P.R. China
§ Department of Radiology, People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, P.R. China

Oncology Research 2020, 28(9), 929-944. https://doi.org/10.3727/096504021X16318716607908

Abstract

This phase II randomized clinical trial aimed to assess the efficacy and toxicity of Endostar, an antiangiogenesis inhibitor, combined with concurrent chemoradiotherapy (CCRT) for locally advanced cervical cancer (LACC). Patients with LACC were randomly assigned to either CCRT plus Endostar (CCRT+E arm) or CCRT alone (CCRT arm). All patients received pelvic intensity-modulated radiation therapy (IMRT) and brachytherapy. Weekly cisplatin was administered concurrently with IMRT. Patients in the CCRT+E arm also received concurrent Endostar every 3 weeks for two cycles. The primary endpoint was progression-free survival (PFS) and acute toxicities. The exploratory endpoint was the impact of vascular endothelial growth factor receptor-2 (VEGFR2) expression on long-term survival. A total of 116 patients were enrolled. Patients in the CCRT+E arm and in the CCRT arm had similar acute and late toxicity profile. The 1- and 2-year PFS were 91.4% versus 82.1% and 80.8% versus 63.5% (p=0.091), respectively. The 1- and 2-year distance metastasis-free survival (DMFS) were 92.7% versus 81.1% and 86.0% versus 65.1% (p=0.031), respectively. Patients with positive VEGFR2 expression had significant longer PFS and overall survival (OS) compared with those with negative VEGFR2 expression. Patients in the CCRT+E arm had significantly longer PFS, OS, and DMFS than those in the CCRT arm when VEGFR2 expression was positive. In conclusion, CCRT plus Endostar significantly improved DMFS but not PFS over CCRT alone. The addition of Endostar could significantly improve survival for patients with positive VEGFR2 expression.

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