Two cases that show the effects of bevacizumab on the recurrence of cervical cancer with pleural effusion

Introduction Bevacizumab has been applied clinically to advanced and recurrent cervical cancer, after showing improved overall survival in the GOG 240 trial. We report two cases of patients with recurrent cervical cancer who showed remarkable decrease in pleural effusion by chemotherapy combined with bevacizumab. Case 1 A 41-year-old patient with stage IIB cervical adenocarcinoma who presented with cervical carcinoma recurrence in the lung and paraaortic/ supraclavicular lymph nodes after primary treatments with concurrent chemoradiotherapy (CCRT), total hysterectomy, and paclitaxel-carboplatin (TC) therapy. As symptomatic pleural effusion emerged after irinotecan-cisplatin therapy and radiotherapy, paclitaxel-cisplatin-bevacizumab (Pac-Cis-Bev) was administered and relieved the pleural effusion promptly and the respiratory distress and back pain symptoms over 13 months. Case 2 The second case involved a 53-year-old patient with stage IIIB cervical squamous cell carcinoma who had a pulmonary recurrence following treatment with CCRT. As pleural effusion emerged at the end of the six-month drug holiday, after a total of 21 cycles of TC or Pac-Cis-Bev therapy to treat the recurrence, topotecan-paclitaxel-bevacizumab (Topo-Pac-Bev) was administered. Respiratory distress was relieved in two weeks, and the pleural effusion disappeared almost completely after two months. The patient received 12 cycles of Topo-Pac-Bev, in total. Conclusion The present two patients have survived over three years, without problematic symptoms, after pulmonary recurrences with pleural effusion, despite that the three-year survival rate for recurrent/metastatic cervical cancer has been reported to be less than 5% without bevacizumab therapy. Chemotherapies that contain bevacizumab present promising regimens for recurrent cases with pleural effusion, despite the uncommon risks of bladder-vaginal or recto-vaginal fistulas.