BEATcc/ENGOT-cx10

Background

Phase III, open-label RCT (n=410) in metastatic, persistent, or recurrent cervical cancer without prior systemic therapy for advanced disease. All patients received a bevacizumab-containing platinum doublet (GOG-240 backbone), testing whether adding atezolizumab improves outcomes, irrespective of PD-L1 status.

Interventions and follow up

Arm A: Atezolizumab 1200mg q3wk + carboplatin AUC5 (or cisplatin 50mg/m²) + paclitaxel 175mg/m² + bevacizumab 15mg/kg q3wk, then atezolizumab + bevacizumab maintenance
Arm B: Carboplatin/cisplatin + paclitaxel + bevacizumab, then bevacizumab maintenance
Primary endpoint: PFS and OS (co-primary)
mFollow-up: 32.9mo

Results

mPFS: 13.7 vs 10.4mo (HR 0.62, 95% CI 0.49–0.78, P=.0014)
mOS: 32.1 vs 22.8mo (HR 0.68, 95% CI 0.52–0.88, P=.0040)
2-yr OS: 63.8% vs 50.1%
ORR: 84% vs 72%

Adverse events

Overall: Grade ≥3 AEs 75.2% vs 60.0%; treatment discontinuation 27.2% vs 10.8%
Immune-mediated: any-grade immune-mediated AEs 23.3% vs 8.0%
Bevacizumab-related: grade ≥3 fistula 4.9% vs 3.4%

Conclusions

Adding atezolizumab to bevacizumab plus platinum-paclitaxel significantly improved PFS (~3.3mo) and OS (~9.3mo) in metastatic/persistent/recurrent cervical cancer, regardless of PD-L1 status, establishing a PD-L1-agnostic first-line option.

Key Limitations

Open-label design; mandatory bevacizumab means benefit demonstrated only within a bevacizumab backbone, excluding patients with contraindications. Markedly higher grade ≥3 AE rate with the 4-drug regimen (75% vs 60%). No head-to-head comparison with the pembrolizumab regimen (KEYNOTE-826).

Clinical Context

FDA and EMA approved atezolizumab with bevacizumab and platinum-paclitaxel for persistent/recurrent/metastatic cervical cancer (2024). Offers a PD-L1-unselected alternative to pembrolizumab (KEYNOTE-826, which requires CPS ≥1 for the chemo doublet). Choice between regimens is guided by availability, PD-L1 status, and bevacizumab eligibility.

References