Moore David H
Gynecologic Oncology of Indiana, Indianapolis, Indiana 46237, USA.
Curr Opin Oncol. 2006 Sep;18(5):516-9. doi: 10.1097/01.cco.0000239893.21161.51.
If chemotherapy becomes the only treatment option for cervical cancer, the prognosis has traditionally been regarded as dismal. Data from several recent trials have demonstrated significant improvements in outcome with specific cisplatin-containing combinations. The purpose of this review is to highlight the evolution of phase III trials leading to current treatment standards.
Given the modest activity of single-agent cisplatin, devoid of any meaningful impact on survival, prospective studies focused on other drugs that might prove either more effective than, or could be used in combination with, cisplatin. Both paclitaxel and topotecan, in combination with cisplatin, yielded superior response rates and progression-free survival without diminishing patient-reported quality of life; however, only cisplatin plus topotecan also improved overall survival. Furthermore, patient-reported quality of life is not diminished despite the greater acute toxicity of combination regimens.
Despite these chemotherapeutic advances, median survival is still less than one year and most patients do not respond to treatment. It is important that investigators identify those patients who should participate in investigational trials of non-platinum-containing regimens. The next generation of clinical trials should explore emerging biological therapies.
如果化疗成为宫颈癌的唯一治疗选择，传统上其预后被认为很差。近期多项试验的数据表明，含顺铂的特定联合方案可显著改善治疗结果。本综述的目的是强调导致当前治疗标准的III期试验的演变。
鉴于单药顺铂活性有限，对生存无任何有意义的影响，前瞻性研究聚焦于可能比顺铂更有效或可与顺铂联合使用的其他药物。紫杉醇和拓扑替康与顺铂联合使用，均产生了更高的缓解率和无进展生存期，且未降低患者报告的生活质量；然而，只有顺铂加拓扑替康还改善了总生存期。此外，尽管联合方案的急性毒性更大，但患者报告的生活质量并未降低。
尽管化疗取得了这些进展，但中位生存期仍不足一年，且大多数患者对治疗无反应。研究人员确定哪些患者应参与不含铂方案的试验很重要。下一代临床试验应探索新兴的生物疗法。
