At the ESMO Congress 2026, Ana Oaknin (Majadahonda, Spain) presented final overall survival (OS) results from the phase III BEATcc trial (NCT03556839), evaluating the addition of atezolizumab to first-line chemotherapy and bevacizumab in patients with metastatic, persistent, or recurrent cervical cancer.
The updated analysis demonstrated a median OS of 31.9 months with atezolizumab plus chemotherapy and bevacizumab, compared with 22.7 months in the control group, representing a 9.2-month improvement and a 31% relative reduction in the hazard of death (HR 0.69; 95% CI, 0.54–0.88).
Methods
BEATcc (ENGOT-Cx10/GEICO 68-C/JGOG1084/GOG-3030) is a randomized phase III trial evaluating the efficacy and safety of adding atezolizumab, a PD-L1 inhibitor, to standard first-line chemotherapy and bevacizumab in patients with metastatic, persistent, or recurrent cervical cancer.
Patients with previously untreated measurable disease not amenable to curative surgery or radiation were randomized 1:1 to receive chemotherapy plus bevacizumab, with or without atezolizumab 1,200 mg intravenously every three weeks.
Treatment continued until disease progression or unacceptable toxicity. Randomization was stratified by previous concomitant chemoradiation, histological subtype, and chemotherapy backbone.
The trial’s dual primary endpoints were progression-free survival (PFS) and overall survival. The final OS analysis also evaluated long-term outcomes across prespecified subgroups, including PD-L1 expression status.
Key Takeaways
At the final analysis, the median follow-up was 57.2 months, and 277 of 410 patients (68%) had died.
- Overall survival: Median OS was 31.9 months with atezolizumab plus chemotherapy and bevacizumab versus 22.7 months with chemotherapy and bevacizumab alone (HR 0.69; 95% CI, 0.54–0.88).
- Four-year survival: OS rates at four years were 40% with atezolizumab versus 26% in the control group.
- Subsequent progression: Median PFS2 was 23.3 months with atezolizumab versus 17.0 months without it (HR 0.62; 95% CI, 0.49–0.78).
- PD-L1-positive tumors (CPS ≥1): Median OS was 32.7 months with atezolizumab versus 26.5 months in the control group (HR 0.71; 95% CI, 0.50–0.99).
- PD-L1-negative tumors (CPS <1): Median OS was 38.6 months versus 19.2 months, respectively (HR 0.53; 95% CI, 0.32–0.88).
- Subsequent immunotherapy: Among 110 patients in the control group who received treatment after progression, 64 (58%) received immunotherapy.
- Long-term safety: Safety findings remained generally consistent with the primary analysis, with no new concerns reported.
The overall survival benefit was maintained across key prespecified subgroups, including patients with different PD-L1 expression levels.
Conclusion
The final BEATcc analysis confirmed a sustained and statistically significant overall survival benefit with the addition of atezolizumab to first-line chemotherapy and bevacizumab in patients with metastatic, persistent, or recurrent cervical cancer.
The 9.2-month improvement in median overall survival, together with a 40% four-year survival rate, reinforces the long-term clinical benefit observed with this immunotherapy-containing regimen.
Exploratory subgroup analyses showed favorable outcomes in both PD-L1-positive and PD-L1-negative tumors, suggesting that PD-L1 expression may not be necessary for selecting patients for this regimen. However, these subgroup findings should be interpreted cautiously.
With extended follow-up confirming the earlier survival benefit and no new safety concerns, BEATcc provides further evidence supporting atezolizumab plus chemotherapy and bevacizumab as a first-line treatment option for eligible patients with advanced cervical cancer.
Source: ESMO Congress 2026, BEATcc Final OS Abstract; BEATcc (NCT03556839).
