No standard treatment is available for patients with recurrent cervical cancer that has spread beyond the confines of a radiation or surgical field. For locally recurrent disease, pelvic exenteration can lead to a 5-year survival rate of 32% to 62% in selected patients.[1,2] These patients are appropriate candidates for clinical trials testing drug combinations or new anticancer agents.
The Gynecologic Oncology Group (GOG) has reported on several randomized phase III trials, (GOG-0179, GOG-0240, which is still active) in this setting with only one regimen being superior in overall survival (OS) to single-agent cisplatin administered intravenously at 50 mg/m� every 3 weeks.[3,4] However, incremental progress was made during the initial six randomized GOG trials that failed to reach their primary endpoint of improving survival. They showed that doubling the doses of cisplatin and adding either ifosfamide or paclitaxel to cisplatin increased the response rates and prolonged time to progression but at a cost of added toxicity and no prolongation of OS. The seventh randomized GOG trial in the setting of stage IVB and recurrent cervical cancer showed that adding topotecan at 0.75 mg/m� on the first 3 days of a 21-day cycle to cisplatin prolonged the median survival by 2.9 months (6.5-9.4 months; P = .017) with an unadjusted relative-risk estimate for survival of 0.76 (95% CI, .593-.979; P = .017, one tailed) compared to cisplatin alone. Although the cisplatin/topotecan doublet is associated with more bone marrow suppression compared to cisplatin alone, there was no associated decrement in quality of life found with the combination.
Every woman should have a regular pelvic exam and Pap test, which tests a cervical cell sample for abnormalities. Together, these procedures detect cervical cancer 95% of the time, often long before the disease produces symptoms.
If your Pap test is abnormal, your doctor may test you again. Recently, some doctors have started to test for HPV at the time of Pap smear. If a high-risk type of HPV is found in women with an abnormal Pap test, doctors are more inclined to do a colposcopy (magnified exam...
Because it was superior to cisplatin alone in response rates and progression-free survival, patients with performance status of 0 or 1 tolerated the combination in the GOG-selected paclitaxel plus cisplatin (PC) regimen in the standard comparator arm for a subsequent trial with 513 patients comparing four cisplatin-based doublets (P-C vs. gemcitabine-C, vinorelbine-C vs. topotecan-C) in patients with advanced and recurrent cervical carcinoma. This study was closed early because of a futility analysis showing no likely differences to emerge. A full publication is awaited.
Standard treatment options:
For recurrence in the pelvis following radical surgery, radiation therapy in combination with chemotherapy (fluorouracil with or without mitomycin) may cure 40% to 50% of patients.
Chemotherapy can be used for palliation. Tested drugs include the following: