The role of topotecan in the treatment of advanced cervical cancer.

Improvements in the early detection of cervical cancer have markedly reduced associated mortality rates over the past few decades; however, in patients diagnosed with cervical cancer the rates have remained unchanged for 25 years. Hysterectomy, alone or with radiotherapy, is effective in early-stage disease, with a high cure rate, but the treatment of advanced and recurrent cervical cancer (usually with radiotherapy and cisplatin) is suboptimal, with 5-year survival rates of 50.9 and 16.5% for patients with regional involvement or distant disease, respectively. There is therefore an unmet need for more effective treatments for patients with advanced disease, and a number of new chemotherapy agents and treatment strategies have been investigated in this setting. Promising results have been reported in phase II trials of the topoisomerase inhibitor I, topotecan. Response rates of up to 19% have been reported in patients treated with topotecan as a single agent and response rates of up to 54% have been achieved when this agent is used in combination chemotherapy regimens. Toxicity levels are similar to those observed in patients with relapsed ovarian cancer and are not significantly different from levels with other chemotherapy agents. This paper reviews the current management of advanced cervical cancer and summarizes the available data on the use of topotecan in this setting.