Immuno-Molecular Targeted Therapy Use and Survival Benefit in Patients with Stage IVB Cervical Carcinoma in Commission on Cancer?-Accredited Facilities in the United States

Simple Summary: Randomized clinical trials show a survival benefit associated with immuno-molecular therapy (IMT) use in metastatic or recurrent cervical cancer. This study investigated IMT use and survival in stage IVB cervical cancer patients in Commission on Cancer (R) (CoC)(R)-accredited facilities. Patients diagnosed with stage IVB cervical cancer in the National Cancer Database and treated with first-line therapy with chemotherapy alone or with radiotherapy +/- IMT were studied. Adjusted risks of death were estimated in patients treated with +/- IMT after applying a propensity score analysis to balance the clinical covariates. There were 3164 evaluable patients, including 31% who were treated with IMT. The use of IMT increased from 11% in 2013 to 46% in 2019. In propensity-score-balanced patients, the median survival was 5 months longer with vs. without IMT. The adjusted risk of death was 28% lower following treatment with vs. without IMT. IMT was associated with a consistent survival benefit in real-world patients in (CoC)(R)-accredited facilities with stage IVB cervical cancer. Purpose: To investigate IMT use and survival in real-world stage IVB cervical cancer patients outside randomized clinical trials. Methods: Patients diagnosed with stage IVB cervical cancer during 2013-2019 in the National Cancer Database and treated with chemotherapy (CT) +/- external beam radiation (EBRT) +/- intracavitary brachytherapy (ICBT) +/- IMT were studied. The adjusted hazard ratio (AHR) and 95% confidence interval (CI) for risk of death were estimated in patients treated with vs. without IMT after applying propensity score analysis to balance the clinical covariates. Results: There were 3164 evaluable patients, including 969 (31%) who were treated with IMT. The use of IMT increased from 11% in 2013 to 46% in 2019. Age, insurance, facility type, sites of distant metastasis, and type of first-line treatment were independently associated with using IMT. In propensity-score-balanced patients, the median survival was 18.6 vs. 13.1 months for with vs. without IMT (p < 0.001). The AHR was 0.72 (95% CI = 0.64-0.80) for adding IMT overall, 0.72 for IMT + CT, 0.66 for IMT + CT + EBRT, and 0.69 for IMT + CT + EBRT + ICBT. IMT-associated survival improvements were suggested in all subgroups by age, race/ethnicity, comorbidity score, facility type, tumor grade, tumor size, and site of metastasis. Conclusions: IMT was associated with a consistent survival benefit in real-world patients with stage IVB cervical cancer.