Chemotherapy for Advanced, Recurrent, and Metastatic Cervical Cancer

Author: David H. Moore MD 1
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  • 1 From Gynecologic Oncology of Indiana, Indianapolis, Indiana.
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When cervical cancer is beyond curative treatment with surgery or radiation therapy, the prognosis is poor and palliation is the primary objective. Early prospective studies identified cisplatin as an active drug for advanced, metastatic, or recurrent cervical cancer, and results with other platinum analogs seemed inferior to cisplatin. Several phase III trials have established the combination of cisplatin plus paclitaxel as standard therapy for comparison. Using pooled data from 3 Gynecologic Oncology Group (GOG) phase III studies, a predictive model was developed to better identify patients who are unlikely to respond to cisplatin-containing chemotherapy. The GOG is currently developing a phase III trial to investigate the impact of bevacizumab and a regimen containing topotecan instead of cisplatin in combination with paclitaxel chemotherapy and also to externally validate the predictive model. This study has the potential to radically change standard care for cervical cancer chemotherapy. Furthermore, if the predictive model is upheld, then patients with high risk factors for treatment failure may be directed to chemotherapy regimens that do not include cisplatin or to investigational trials.

Correspondence: David H. Moore, MD, Gynecologic Oncology of Indiana, 5255 East Stop 11 Road, Suite 310, Indianapolis, IN 46237. E-mail: David.Moore@ssfhs.org
  • 1.

    Jemal A, Siegel R, Ward E. Cancer statistics, 2007. CA Cancer J Clin 2007;57:4366.

  • 2.

    Thigpen JT, Shingleton H, Homesley H. Cis-platinum in treatment of advanced or recurrent squamous cell carcinoma of the cervix: a phase II trial of the Gynecologic Oncology Group. Cancer 1981;48:899903.

    • Search Google Scholar
    • Export Citation
  • 3.

    Bonomi P, Blessing JA, Stehman FB. Randomized trial of three cisplatin dose schedules in squamous-cell carcinoma of the cervix: a Gynecologic Oncology Group study. J Clin Oncol 1985;3:10791085.

    • Search Google Scholar
    • Export Citation
  • 4.

    Thigpen JT, Blessing JA, DiSaia PJ. A randomized comparison of rapid versus prolonged (24 hr) infusion of cisplatin in therapy of squamous cell carcinoma of the uterine cervix: a Gynecologic Oncology Group study. Gynecol Oncol 1989;32:198202.

    • Search Google Scholar
    • Export Citation
  • 5.

    McGuire WP III, Arseneau JC, Blessing JA. A randomized comparative trial of carboplatin and iproplatin in advanced squamous carcinoma of the uterine cervix: a Gynecologic Oncology Group study. J Clin Oncol 1989;7:14621468.

    • Search Google Scholar
    • Export Citation
  • 6.

    Omura GA, Blessing JA, Vaccarello L. A randomized trial of cisplatin versis cisplatin plus mitolactol versus cisplatin plus ifosfamide in advanced squamous carcinoma of the cervix: a Gynecologic Oncology Group study. J Clin Oncol 1997;15:165171.

    • Search Google Scholar
    • Export Citation
  • 7.

    Bloss JD, Blessing JA, Behrens BC. Randomized trial of cisplatin and ifosfamide with or without bleomycin in squamous carcinoma of the cervix: a Gynecologic Oncology Group study. J Clin Oncol 2002;20:18321837.

    • Search Google Scholar
    • Export Citation
  • 8.

    Moore DH, Blessing JA, McQuellon RP. Phase III study of cisplatin with or without paclitaxel in stage IVB, recurrent, or persistent squamous cell carcinoma of the cervix: a Gynecologic Oncology Group study. J Clin Oncol 2004;22:31133119.

    • Search Google Scholar
    • Export Citation
  • 9.

    Long HJ, Bundy BN, Grendys EC. Randomized phase III trial of cisplatin with or without topotecan in carcinoma of the uterine cervix: a Gynecologic Oncology Group study. J Clin Oncol 2005;23:46264633.

    • Search Google Scholar
    • Export Citation
  • 10.

    Monk BJ, Huang HQ, Cella D, Long HJ. Quality of life outcomes from a randomized phase III trial of cisplatin with or without topotecan in advanced carcinoma of the cervix: a Gynecologic Oncology Group study. J Clin Oncol 2005;23:46174625.

    • Search Google Scholar
    • Export Citation
  • 11.

    Moore DH. Combined chemotherapy and radiation therapy for cervical cancer. J Natl Compr Canc Netw 2004;2:631635.

  • 12.

    National Cancer Institute. Concurrent chemoradiation for cervical cancer. Clinical Announcement, Washington, D.C., February 22, 1999.

  • 13.

    Tinker AV, Bhagat K, Swenerton KD, Hoskins PJ. Carboplatin and paclitaxel for advanced and recurrent cervical carcinoma: the British Columbia Cancer Agency experience. Gynecol Oncol 2005;98:5458.

    • Search Google Scholar
    • Export Citation
  • 14.

    Nagao S, Fujiwara K, Oda T. Combination chemotherapy of docetaxel and carboplatin in advanced or recurrent cervix cancer. A pilot study. Gynecol Oncol 2005;96:805809.

    • Search Google Scholar
    • Export Citation
  • 15.

    Moore DH, Tian C, Monk BJ. Factors predictive of response to cisplatin-based chemotherapy in stage IVB persistent or recurrent cervical carcinoma: a multivariate analysis of three Gynecologic Oncology Group trials [abstract]. J Clin Oncol 2007;25(Suppl 1):282s. Abstract 5534.

    • Search Google Scholar
    • Export Citation
  • 16.

    Bonner JA, Giralt J, Harari PM. Cetuximab prolongs survival in patients with locoregionally advanced squamous cell carcinoma of head and neck: a phase III study of high dose radiation therapy with or without cetuximab [abstract]. J Clin Oncol 2004;22(Suppl 1):Abstract 5507.

    • Search Google Scholar
    • Export Citation
  • 17.

    Mathur SP, Mathur RS, Rust PF. Human papilloma virus (HPV)-E6/E7 and epidermal growth factor receptor (EGF-R) protein levels in cervical cancer and cervical intraepithelial neoplasia (CIN). Am J Reprod Immunol 2001;46:280287.

    • Search Google Scholar
    • Export Citation
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