Sixteen years of systemic therapy for advanced cervical cancer in Armenia: Treatment patterns, disease burden, and survival outcomes from the National Oncology Centre (2008–2024)

Abstract

Cervical cancer disproportionately affects low- and middle-income countries, yet real-world treatment data from many regions remain scarce. We aimed to describe treatment patterns, disease burden, and survival outcomes in patients with advanced cervical cancer treated at Armenia's national referral centre. We conducted a retrospective cohort study of consecutive patients with advanced cervical cancer who received paclitaxel-platinum chemotherapy at the national oncology centre between January 2008 and August 2024. Treatment response was assessed clinically and radiologically after the first chemotherapy course. Overall survival was estimated using the Kaplan-Meier method with 95% confidence intervals. Temporal trends were examined across three treatment eras. A total of 159 patients were included (mean age 51.7 ± 10.2 years). The majority presented with advanced disease: 87.9% had International Federation of Gynaecology and Obstetrics (FIGO) stage III–IV, and 57.2% had distant metastases. Treatment regimens included paclitaxel-carboplatin (63.5%) and paclitaxel-cisplatin (35.2%); 38.4% received bevacizumab. The overall response rate was 48.4%, and the disease control rate was 64.2%. Median overall survival was 36.0 months (95% CI: 26.0–56.0). Bevacizumab use varied across eras (35.7% in 2008–2014, 20.0% in 2015–2018, and 53.2% in 2019–2024), whilst stage III–IV presentation increased from 78.6% in 2008–2014 to 91.0% in 2019–2024. Despite late-stage presentation typical of low- and middle-income countries, survival outcomes were broadly consistent with international real-world data. The rising proportion of advanced-stage disease highlights the urgent need for improved screening programmes.