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Xia Tao
a,b
, Wei Hu
a
, Pedro T. Ramirez
a
, John J. Kavanagh
a,
a
Department of Gynecologic Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
b
Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
Received 18 April 2008
Available online 3 June 2008
Abstract
Objectives. Our purpose is to review the chemotherapy for recurrent and metastatic cervical cancer.
Methods. We reviewed the phase II and III clinical trials of chemotherapy regimens and recent advances of targeted therapy for treatment of
recurrent and metastatic cervical cancer. We also reviewed chemotherapy for rare histological subtypes of cervical cancer.
Results. Recent data has shown that the combination of cisplatinum and topotecan is the only regimen to demonstrate a progression-free
survival and overall survival advantage over single agent cisplatin in the setting of recurrent cervical cancer. Preliminary study results indicate that
targeted therapies may have an important role in the management of recurrent or metastatic cervical cancer.
Conclusion. There remains a need for novel agents and further research focusing on the management of recurrent and metastatic cervical
cancer. Future goals of therapy are to increase efficacy of treatment options while decreasing toxicity.
2008 Elsevier Inc. All rights reserved.
Keywords: Chemotherapy; Cervical cancer; Recurrent and metastatic
Introduction
According to the American Cancer Society's Global Cancer
Facts and Figures 2007, an estimated 555,094 new cases of
cervical cancer occurred worldwide in 2007, and 309,808
people died of the disease. More than 85% of the new
cases and deaths (an estimated 473,430 and 272,238 cases,
respectively) occurred in developing countries [1]. In the
United States, an estimated 11,150 new cases of invasive
cervical cancer were diagnosed in 2007, and 3,670 people died
of the disease [2].
Two inspiring landmarks have occurred in the fight against
cervical cancer. First, the development of the Papanicolaou
smear in 1943 made possible the screening and early detection
of the disease. Second, a study by Koutsky and colleagues
established the efficacy of the human papillomavirus (HPV)
vaccine in preventing cervical dysplasia [3], and the HPV
vaccine was approved by the U.S. Food and Drug Administra-
tion in 2006 [4]. Despite these innovations, one third of patients
with invasive cervical cancer die from recurrent or metastatic
disease and the lack of an optimal treatment option.
Systematic chemotherapy remains the major treatment modal-
ity for recurrent or metastatic cervical cancer. The intent of che-
motherapy is sufficient palliation because of the aggressive nature
of the disease and the toxicity of the drugs. Thus, effective pal-
liation and social support should be the considerations when
making treatment decisions.
Fifty-eight cytotoxic agents have been tested in recurrent or
advanced cervical cancer, 21 of themhad activity with a response
rate of 15%or greater [5]. The most active single agents have been
cisplatin, paclitaxel, topotecan, vinorelbine, and ifosfamide [6].
We reviewed the findings of randomized, controlled phase II and
phase III trials, especially GOG studies, which have reported
active single-agent and combined-agent chemotherapy regimens
and of targeted therapies for recurrent cervical cancer. We also
reviewed the chemotherapy for rare histological subtypes of
Available online at www.sciencedirect.com
Gynecologic Oncology 110 (2008) S67S71
www.elsevier.com/locate/ygyno