The role of cisplatin in the management of advanced squamous cell cancer of the cervix.

Cisplatin has emerged as the most active agent in the treatment of patients with advanced cervical cancer. While no other standard cytotoxic agent has been associated consistently with objective response rates in excess of 20%, single-agent cisplatin has produced clinical complete response (CR) rates of up to 33% in previously untreated patients. The results of over 25 phase II cisplatin combination chemotherapy trials show overall objective response and clinical CR rates ranging to 65% and 36%, respectively. However, patient survival durations in these studies (median range, 4 to 10.5 months) appear similar to those observed in patients treated with single-agent cisplatin, suggesting that cisplatin activity is not enhanced by the addition of other agents in the treatment of this disease. Cisplatin's documented radiopotentiating effects have led to more than 20 phase II pilot studies of cisplatin-based regimens before or concurrent with definitive radiation therapy to the pelvis for advanced, previously untreated disease. The overall objective response rates to preradiation chemotherapy in these studies range from 31% to 100%; however, survival durations do not appear prolonged. In contrast, patients who received concurrent pelvic irradiation and cisplatin-based chemotherapy survived between 12+ and 36+ months. These encouraging results have led to phase III trials of this combined-modality approach that may irrevocably change the management of patients with previously untreated, advanced cervical cancer.