Chemotherapy for recurrent cervical cancer

https://doi.org/10.1016/j.ygyno.2007.07.004Get rights and content

Abstract

Objective

To give an overview of chemotherapy schemes used in recurrent cervical cancer.

Methods

A pubmed search was performed using chemotherapy and recurrent cervical cancer including articles until April 2007.

Results

Most recent articles and articles of interest are discussed.

Conclusion

Single agent cisplatin (50 mg/m2) remains the current standard for recurrent cervical cancer. Numerous chemotherapeutic agents have been tested but did not show convincing evidence of improved survival rates, except for the GOG 179 study which showed an improved survival for the combination of cisplatin and topotecan compared with single agent cisplatin. However, nearly 60% of patients in both groups received prior cisplatinum therapy as a radiosensitizer, which could be responsible for the development of platinum resistance, causing lower response and survival rates in the single platinum group. Hence, the apparent benefit in the doublet group is maybe just a reflection from the change in primary therapy and patient population.

It is hoped that current trials comparing standard therapy with other single or doublet chemotherapeutic regimens or that the use of molecular-targeted agents will give us promising therapeutic options in the future.

Introduction

Cervical cancer represents one of the leading causes of death from cancer in relative young women accounting for an estimated 11,150 new cases and 3670 deaths in USA for 2007 [1]. Patients with recurrent disease or pelvic metastases have a poor prognosis with a 1-year survival rate between 15 and 20% [2].

Single agent cisplatin is the current standard chemotherapeutic agent, with response rates (RR) ranging from 20 to 30% and an OS of 7 months [3]. In some countries, the combination of cisplatin and topotecan is preferred since this is the only regimen which was able to show a statistical significant improvement of OS (9.4 months) without impairing quality of life due to intolerable toxicity [4].

But one has to be careful, because due to a change in primary therapy since 1999, when concomitant chemotherapy and radiotherapy became standard [5], [6], [7], [8], [9], [10], [11], and due to the current investigation of the role of neo-adjuvant chemotherapy (EORTC 55994 [12]), most people with recurrent cervical cancer will have had some challenge with a chemotherapeutic agent. This will influence responses in secondary treatment lines and will limit comparison of new studies with older ones including more chemonaive patients.

In this review, we would like to highlight the latest trials reported on chemotherapy and recurrent cervical cancer.

Section snippets

Single agent chemotherapy

Initial GOG data reported RR of 50% in chemonaive women with cisplatin 50 mg/m2 [13] though a study done by Bonomi et al. [3], including 497 women, revealed RR of 20–30%. Three dose schedules were tested (50 mg/m2, 100 mg/m2 on day 1 or 20 mg/m2/day delivered over 5 days; repeated every 21 days), and median survival (7.1, 7.0 and 6.1 months) and PFS (3.7, 4.6 and 3.9 months) were similar between the three regimens although a lower toxicity rate was observed with the lower dose. This established

Conclusion

Cisplatin-topotecan for recurrent cervical cancer resulted in a higher OS compared with single agent cisplatin. However, this improvement is rather small and could be due to the increase in platinum resistance due to first line platinum-based therapy. Results of the GOG-0204 trial will hopefully give some answers regarding the superiority of topotecan and needs to be awaited.

Future trials are necessary, not only to compare combinations of existing agents but also to broaden the expertise on

Conflict of interest statement

We declare that we have no conflict of interest.

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