Chemotherapy for metastatic cervical cancer

Metastatic cervical cancer responds moderately to chemotherapy and it can provide palliation. One guideline writes: "It is recommended that all patients, particularly those who have been previously treated with cisplatin as a radiosensitizer, be offered the opportunity to participate in randomized trials, if available, that evaluate the efficacy and toxicity of other single-agent or combination chemotherapy regimens.
Until further evidence becomes available, it is recommended that cisplatin in combination with topotecan should be offered to patients on the basis of improvements in response and survival outcomes when compared with single-agent cisplatin alone." However NCCN is more liberal, lisitng in addition carboplatin and cisplatin/paclitaxel, cisplatin/gemcitabine and a variety of single agents.

There was a recent study of single agent Avastin. To evaluate Avastin in the treatment of recurrent squamous cell carcinoma of the cervix, researchers conducted a Phase II clinical trial among 46 women. Study participants received intravenous Avastin every three weeks until cancer progression or the development of severe side effects.

24% of patients survived progression-free for at least six months.
11% of patients had a partial response.
Median response duration was 6.2 months.
Median overall survival was 7.3 months.
Median progression-free survival was 3.4 months.
There was one infection-related death that was possibly due to treatment.
Side effects included hypertension and thromboembolism

These researchers concluded that Avastin was generally well tolerated and appeared to have anticancer activity in women with previously treated recurrent cervical cancer. They note that the role of Avastin in this population merits further study in Phase III clinical trials. A combination phase II trial with topotecan reported as an abstract concluded: "Combination bevacizumab and topotecan administered in a weekly fashion demonstrate good activity in platinum refractory OC with acceptable toxicity."  There were also trials with 5FU or capecitbine.

For second line therapy, NCCN on page Papillae CER V – be recommence Avastin, docetaxel, 5-FU, gemcitabine, ifosfamide, irinotecan, mitomycin, topotecan. This is a category 2B recmmendation. Premetrexed and vinorelbine are recommended as category 3.

 There are no FDA approved chemotherapy drugs specifically for cervical cancer.

Hirte H, Strychowsky J, Oliver T, Fung-Kee-Fung M, Elit L, Oza A, Gynecology Cancer Disease Site Group. Chemotherapy for recurrent, metastatic, or persistent cervical cancer: a clinical practice guideline. Toronto (ON): Cancer Care Ontario (CCO); 2006 Jul 5. 21 p. (Evidence-based series; no. 4-20). [27 references]

nccn.org, cervical cancer, CERV-B

Wright JD, Viviano D, Powell MA et al. BevacizWright JD, Viviano D, Powell MA et al. Bevacizumab Combination Therapy in Heavily Pretreated, Recurrent Cervical Cancer. Gynecologic Oncology. 2006;103:489-493.

Reference: Monk BJ, Sill MW, Burger RA et al. Phase II trial of bevacizumab in the treatment of persistent or recurrent squamous cell carcinoma of the cervix: a Gynecologic Oncology Group Study. Journal of Clinical Oncology. 2009;27:1069-1074.

K. F. McGonigle, H. G. Muntz, J. L. Vuky, P. J. Paley, D. S. Veljovich, H. J. Gray, T. W. Malpass Phase II prospective study of weekly topotecan and bevacizumab in platinum refractory ovarian cancer or peritoneal cancer (OC). J Clin Oncol 26: 2008 (May 20 suppl; abstr 5551)

Comments

[lw]

I received the above described chemo combinations for approximately 11 months and stopped after 2 clear quarterly PET scans and thrombocyclopenia (treated with NPlate) and other side-effects became increasingly difficult. I have had 6 metastatis of cervical cancer since original diagnosis, surgery, radiation and chemo in Nov. 2007 (mostly regional and two distant metastasis), and am at 85% of pre-cancer energy and productivity with excellent quality of life. I comment to encourage others that you can beat the statistics.

[Oncology Doylestown]

Thanks lw for posting that, its very inspiring. This website provides great statistics and information that can also be scary. But its important to keep a positive attitude through these situations.