PARIS – Although survival remains relatively poor, the options for the management of metastatic, recurrent, or persistent cervical cancer have increased in recent years, with bevacizumab-enhanced, platinum-based, combination chemotherapy becoming the “new standard” for many women according to medical oncologist Isabelle Ray-Coquard.
Speaking at a recent international conference on anticancer treatment, Dr. Ray-Coquard of Centre Léon Bérard in Lyon, France, noted that there are several questions that the medical oncologists must address before prescribing treatment. These are: Would the patient benefit from chemotherapy and if so, should a single-agent or a combination be used? Is the patient a candidate for a new or novel agent? Or would palliative care be the best option? How can patients best be selected for treatment?
Dr. Isabelle Ray-Coquard
“We have some strong data to support the use of cisplatin first line,” she observed. “Cisplatin is probably the first actor in the management of cervix cancer.” Response rates using single-agent cisplatin have ranged from 18% to 25% in women with recurrent and advanced carcinoma of the cervix.
“The question is what is the best partner for cisplatin?” Dr. Ray-Coquard asked. She highlighted several studies showing the activity of other cytotoxic chemotherapies as single agents, with the highest responses seen with paclitaxel (Taxol, at 19% of patients), followed by vinorelbine (Navelbine, 18%), irinotecan (Campto, 17%), topotecan (Hycamtin, 16%), docetaxel (Taxotere, 13%), and the lowest with gemcitabine (Gemzar, 8%).
Both paclitaxel and topotecan have been studied in combination with cisplatin vs. cisplatin alone and been shown to confer survival benefits. In the Gynecologic Oncology Group (GOG) 169 study (J. Clin. Oncol. 2004;22:3113-9), for example, paclitaxel plus cisplatin was associated with a significant (P < .001) increase in progression-free survival (PFS) of 4.8 vs. 2.8 months, although overall survival (OS) was not statistically different (9.7 vs. 8.8 months). Dr. Ray-Coquard noted, however, that paclitaxel had been given to women randomized to cisplatin at relapse, which might have clouded the OS benefit.
Similar benefits were seen when topotecan and cisplatin were combined and compared against single agent cisplatin in the GOG 179 study (J. Clin. Oncol. 2005;23:4626-33), with median PFS of 4.6 vs 2.9 months (P = .014) and median OS of 9.4 and 6.5 months (P = .017).