Dr Farolfi on Real-World Outcomes With Bevacizumab Plus SOC in Cervical Cancer

“Patients who received bevacizumab [experienced] a reduced incidence of pulmonary embolism. This may seem unexpected at first, but it raises the hypothesis that bevacizumab could enhance the overall efficacy of treatment. This improved efficacy might in turn reduce the tumor-driven risk of thrombosis, which could explain the observed decrease in pulmonary embolism events."

Alberto Farolfi, MD, PhD, a medical oncologist at Romagnolo Scientific Institute for the Study and Treatment of Tumors, discussed findings from a real-world study assessing the efficacy of first-line quadruplet therapy with bevacizumab (Avastin) plus standard-of-care platinum-based chemotherapy and pembrolizumab (Keytruda) in patients with advanced cervical cancer who have no known contraindications for antiangiogenic agents.

Data from the study were presented at the 2025 ESMO Gynecological Cancers Congress. The study demonstrated that overall, the addition of bevacizumab was associated with improved clinical outcomes, Farolfi began. In particular, the combination regimen of bevacizumab plus pembrolizumab produced a survival advantage, with a median overall survival that was not reached in the bevacizumab-treated cohort. This study also included subgroup analyses that stratified patients by the type of platinum-based chemotherapy they received, he noted.

Importantly, the incorporation of bevacizumab did not result in an increased incidence of treatment-related adverse effects, according to Farolfi. Although initial concerns existed regarding the potential for serious bevacizumab-associated toxicities—such as gastrointestinal fistula formation, bowel perforation, or pulmonary embolism—the analysis confirmed no significant difference in the frequency of these complications between patients who received bevacizumab and those who did not, he explained.

Notably, patients treated with bevacizumab experienced a lower incidence of pulmonary embolism, Farolfi said. Although this observation may appear counterintuitive, it supports the hypothesis that bevacizumab may augment the antitumor efficacy of therapy, he reported. Enhanced disease control could subsequently mitigate the tumor-mediated prothrombotic risk, providing a biologically plausible explanation for the observed reduction in pulmonary embolic events, he concluded.