Atezolizumab plus chemo, bevacizumab improves survival in R/M cervical cancer

The addition of atezolizumab to first-line chemotherapy plus bevacizumab delivers significant improvements in survival among patients with PD-L1+ or PD-L1‒ persistent, recurrent, or metastatic (R/M) cervical cancer, results of a post hoc analysis of the BEATcc study have shown.

This post hoc analysis also revealed that PD-L1 may not be an effective biomarker in guiding patient selection for immunotherapy in R/M cervical cancer.

“BEATcc confirms the clinical benefit of combined inhibition of immunosuppression and angiogenesis in R/M cervical cancer,” said one of the study authors Dr Kristina Lindemann, NSGO-CTU, Oslo University Hospital and University of Oslo, Oslo, Norway.

Lindemann and her team randomly assigned 410 patients with previously untreated measurable R/M cervical cancer not amenable to curative surgery or radiation to standard chemotherapy plus bevacizumab (every 3 weeks) or to chemotherapy plus bevacizumab and atezolizumab (1,200 mg day 1 every 3 weeks) until disease progression or unacceptable toxicity.

In the post hoc analyses, the research team assessed progression free survival (PFS), overall survival (OS), and PFS2 (secondary endpoint) according to PD-L1 immunohistochemistry 22C3 status, as assessed by combined positive score (CPS) using cutoffs of 1 and 10.

Finally, hazard ratios (HRs) were calculated using stratified Cox regression analyses, while the predictive value of PD-L1 status was explored through interaction tests.

Of the participants, 313 (76 percent) were included in the biomarker population. In this subgroup, baseline characteristics were balanced between groups and representative of the intent-to-treat (ITT) population. [ESMO Gyn 2025, abstract 10O]

Improved survival

All survival outcomes improved with atezolizumab regardless of PD-L1 status: PFS (HR, 0.53, 95 percent confidence interval [CI], 0.41‒0.69), PFS2 (HR, 0.57, 95 percent CI, 0.42‒0.75), and OS (HR, 0.60, 95 percent CI, 0.45‒0.82). Results in the CPS ≥1 subgroup (n=220) were similar: PFS (HR, 0.54, 95 percent CI, 0.39‒0.74), PFS2 (HR, 0.62, 95 percent CI, 0.44‒0.88), OS (HR, 0.73, 95 percent CI, 0.51‒1.06).

Notably, CPS did not demonstrate any predictive effect in interaction tests for PFS (p=0.73), PFS2 (p=0.53), or OS (p=0.12). In subgroup analyses within the CPS <1 and ≥1 populations, results were consistent: PFS (CPS <1: HR, 0.48, 95 percent CI, 0.28‒0.82; CPS ≥1: HR, 0.54, 95 percent CI, 0.39‒0.74) and OS (CPS <1: HR, 0.43, 95 percent CI, 0.24‒0.77; CPS ≥1: HR, 0.73, 95 percent CI, 0.51‒1.06).

“Results from this post hoc analysis suggest that adding atezolizumab to bevacizumab plus chemotherapy provides similar benefit in R/M cervical cancer regardless of CPS,” Lindemann said.

“Atezolizumab plus bevacizumab plus CT represents an effective first-line treatment option for patients with R/M cervical cancer and should be offered irrespective of CPS,” she added.

The BEATcc regimen is one of the preferred first-line treatments for R/M cervical cancer in the guidelines set by the National Comprehensive Cancer Network. [https://www.nccn.org/professionals/physician_gls/pdf/cervical.pdf]

The final OS results for BEATcc are expected to come out in 2026, according to Lindemann.