Satoshi Yamaguchi

Atezolizumab, bevacizumab, and platinum chemotherapy in cervical cancer: results of Japanese population from BEATcc

This study analyzed the efficacy of add-on atezolizumab to standard first-line bevacizumab-containing therapy in 56 Japanese patients with metastatic and recurrent cervical cancer treated across 8 sites under the Japanese Gynecologic Oncology Group between October 2018 and August 2021 in the BEATcc trial. Patients were randomized to standard arm (standard therapy: cisplatin 50 mg/m² or carboplatin area under the curve of 5, paclitaxel 175 mg/m², and bevacizumab 15 mg/kg) or experimental arm (standard therapy with atezolizumab 1,200 mg). Of 56 patients, 30 were in experimental arm vs. 26, standard arm (age: 53.2±12.9 vs. 54.7±12.2 years). Median progression-free survival was 15.8 months (95% confidence interval [CI]=10.4-26.1) in experimental arm vs. 11.1 months (8.4-16.5) in standard arm (hazard ratio [HR]=0.51; 95% CI=0.26-1.01). Median overall survival was 34.1 months (23.2-38.6) in the experimental arm vs. 31.6 months (16.4-36.5), standard arm (HR=0.53; 95% CI=0.23-1.21). Objective response rate was 86.7% in experimental arm vs. 84.6%, standard arm. Complete response and partial response, respectively, were 23.3% and 63.3% in experimental arm and 26.9% and 57.7% in standard arm. Grade ≥3 adverse events occurred in 80.0%, experimental arm and 88.5%, standard arm. Gastrointestinal/genitourinary fistula incidence was lower in Japanese patients (1 patient receiving atezolizumab), likely due to stricter inclusion criteria. Overall, add-on atezolizumab enhances the efficacy of bevacizumab and chemotherapy in Japanese patients as those in overall BEATcc population and could be considered a new first-line treatment option for metastatic, persistent, or recurrent cervical cancer in Japan. ClinicalTrials.gov Identifier: NCT03556839.

Impact of Nodal Metastatic Volume on Distant Metastasis in Patients with Cervical Cancer and Para-aortic Nodal Metastases Treated With Definitive Radiation Therapy

To report institutional outcomes following definitive radiation therapy (RT) for cervical cancer with para-aortic lymph node (PAN) metastasis and explore the risk factors for subsequent distant metastasis (DM) and the optimal elective radiation field. Ninety-seven patients treated between 2011 and 2023 were evaluated. The median patient age was 60 (range, 29-86) years. The numbers of patients with International Federation of Gynecology and Obstetrics (FIGO) 2008 stages I, II, III, and IVA were 6 (6%), 32 (33%), 43 (44%), and 16 (16%), respectively. Eighty-two patients had squamous cell carcinoma. The median gross tumor volumes of primary (GTVp) and nodal metastasis (GTVn) were 110.4 (range, 20.6-340.7) cm With a median follow-up of 34 (range, 4-143) months, the 3-year in-field recurrence-free survival, DM-free survival, and overall survival rates were 74%, 51%, and 66%, respectively. Patients with a higher GTVn/GTVp ratio had a significantly higher risk of developing DM than their counterparts. Only two (2%) patients developed isolated PAN recurrence outside the irradiated field. DM is the most common mode of recurrence, the risk of which is significantly higher in patients with higher GTVn/GTVp ratios. An ample margin above the involved PAN may not necessarily be required to achieve disease control in the pelvis and PAN.

Diagnostic accuracy and prognostic factors of uterine serous carcinoma in Japanese women: a multi-center study

This multi-center retrospective study aimed to clarify the characteristics, diagnostic accuracy, treatment outcomes, and prognostic factors of uterine serous carcinoma (USC) in Japanese women. The medical records of 193 patients who were treated between 2006 and 2008 at 24 participating institutions in the Japanese Clinical Oncology Group were examined, and pathological slides of 188 patients were re-checked through central pathology review (CPR), hematoxylin-eosin staining, and immunohistochemistry. USC was confirmed in 144 of the 188 (76.6%) patients using CPR, and only 50% were correctly diagnosed preoperatively. Forty-three patients were diagnosed with non-serous carcinoma, whereas one patient had metastasis from another organ. The average age was 65.7 years, and 19% of patients had a history of other cancers. The incidence of stage III-IV disease was 52.8%, and lymph node metastasis was found in 28.5% of patients. Extrauterine spread and distant metastasis occurred in 39% and 14% of patients, respectively. The 2-year overall survival and progression-free survival (PFS) rates were 56% and 42%, respectively. The PFS of patients with stage I and II who underwent complete staging surgery was 92.3%, and that of those without lymph node dissection or omentectomy was 33.3%. Patients with USC had a significantly worse prognosis than 43 patients with non-serous carcinoma. USC in Japanese women has characteristics different from those of endometrioid carcinoma, worse prognosis, and is difficult to diagnose preoperatively. Complete surgical staging is necessary even for early-stage disease. Additionally, new adjuvant treatment strategies, including molecular targeted therapy, should be explored.