Charles A Leath1, J Michael Straughn. 1. Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA. Trey_Leath@yahoo.com
Abstract
OBJECTIVE: To review the clinical trial experience with chemotherapy for patients with primary Stage IVB, persistent and recurrent cervical cancer. METHODS: PubMed and cooperative group website search was performed and included clinical trials until September 2012. Emphasis was placed on the phase II and III clinical trial experience of the Gynecologic Oncology Group. RESULTS: Experience and trial results with single agents and combination agents in phase II settings are reviewed. Cisplatin has been considered as the most effective agent for metastatic cervical cancer. Most patients who develop metastatic disease have received cisplatin with concurrent radiation and may no longer be sensitive to single-agent therapy. Therefore, cisplatin-based combination chemotherapy regimens have been extensively studied and eight sentinel phase III trials are discussed in this review. CONCLUSION: Based on phase III results, the combination of cisplatin and paclitaxel remains the standard of care; however, alternative combination therapies including cisplatin/topotecan and cisplatin/gemcitabine may be acceptable considerations for patients when considering potential toxicities. Further research is necessary to determine the optimal therapy for this group of patients. Final data from GOG 240 and JCOG 0505 will likely contribute to the design of future clinical trials in this disease setting.
OBJECTIVE: To review the clinical trial experience with chemotherapy for patients with primary Stage IVB, persistent and recurrent cervical cancer. METHODS: PubMed and cooperative group website search was performed and included clinical trials until September 2012. Emphasis was placed on the phase II and III clinical trial experience of the Gynecologic Oncology Group. RESULTS: Experience and trial results with single agents and combination agents in phase II settings are reviewed. Cisplatin has been considered as the most effective agent for metastatic cervical cancer. Most patients who develop metastatic disease have received cisplatin with concurrent radiation and may no longer be sensitive to single-agent therapy. Therefore, cisplatin-based combination chemotherapy regimens have been extensively studied and eight sentinel phase III trials are discussed in this review. CONCLUSION: Based on phase III results, the combination of cisplatin and paclitaxel remains the standard of care; however, alternative combination therapies including cisplatin/topotecan and cisplatin/gemcitabine may be acceptable considerations for patients when considering potential toxicities. Further research is necessary to determine the optimal therapy for this group of patients. Final data from GOG 240 and JCOG 0505 will likely contribute to the design of future clinical trials in this disease setting.
Authors: David Scott Miller; John A Blessing; Lois M Ramondetta; Huyen Q Pham; Krishnansu S Tewari; Lisa M Landrum; Jubilee Brown; Robert S Mannel Journal: J Clin Oncol Date: 2014-07-28 Impact factor: 44.544