Standard of care treatment for stage IVB cervical cancer: A systematic review and meta-analysis

Objective: Our aim was to perform a systematic review and meta-analysis evaluating the efficacy of standard treatment for stage IVB cervical cancer. Method: Databases were searched for Phase III trials evaluating stage IVB CC patients according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. Systematic review included Phase III trials evaluating first-line treatment of stage IVB cervical cancer (CC). A meta-analysis was pursued for Phase III trials establishing standard of care treatment that included independent analyses of stage IVB, persistent, and recurrent CC. Results: For the systematic review, 8 studies met inclusion criteria, with a total of 3,161 CC patients analyzed. Of these studies, three met criteria and included suitable data for meta-analysis – GOG 240, KEYNOTE-826, and BEATcc. Of the 1,479 women included in the meta-analysis, 289 (19.5 %) had stage IVB and 1,190 (80.5 %) had persistent or recurrent CC. HR of OS was 0.64 (95 % confidence interval (CI): 0.55–0.75) and 0.85 (95 % CI: 0.64–1.14) for persistent/recurrent and stage IVB CC, respectively. In the test of group differences, p-value was insignificant at 0.098. Conclusion: While trials have assessed outcomes in stage IVB, persistent, and recurrent CC, new treatments demonstrate poorer PFS and OS for stage IVB compared to persistent and recurrent CC. The exact benefit for current standard of care for stage IVB CC could be better defined. Given that stage IVB CC has a different clinical course and treatment history compared to persistent and recurrent disease, stage IVB CC should be analyzed independently in future clinical trials.