Bradley J. Monk, MD, FACOG, FACS: Safety Concerns Regarding Treatment

Dr. Monk states, ass shown in GOG 240, treating cervical cancer with bevacizumab is unique in that the risk of vaginal fistulas is higher than when bevacizumab is added to chemotherapy when treating lung or colorectal cancer. The risk of rectal and bladder fistulas is almost 4 times higher, affecting about 8% of cervical cancer patients. The other side effects of chemotherapy and anti-VEGF therapy are not increased in women with cervical cancer.

CASE 2: Cervical Cancer

Stephanie M. is a 48-year-old Caucasian mother of 2 children who works as a dental hygienist.

She presented to her PCP in May 2012 with vaginal discharge and pain during intercourse. Prior medical history was notable for smoking (quit 3 years ago) and well-controlled hypertension. Patient had completed only sporadic cervical screening for the past 10 years.

• Subsequent Pap smear showed the presence of squamous intraepithelial lesions and HPV-16 positivity
• She was referred to oncologist for further evaluation. Ultrasound and colposcopy showed the presence of a 3.0-cm lesion in cervix with extension into the vagina. Patient was diagnosed with squamous cell carcinoma FIGO stage 1B1
• Patient underwent radical hysterectomy with pelvic lymphadenectomy, with 3 positive pelvic nodes
• She received pelvic radiotherapy with concurrent weekly cisplatin
• Patient remained disease free for approximately 2 years

In September 2014, she presented with worsening abdominal pain and fatigue. CT scan showed diffuse pelvic and aortic adenopathy consistent with disease recurrence. Her renal and hepatic function were adequate.

• Patient received treatment with cisplatin/paclitaxel for metastatic disease
• After 3 cycles, patient presents with worsening pain and CT evidence of disease progression