Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA.
Gynecol Oncol. 2013 Apr;129(1):251-7. doi: 10.1016/j.ygyno.2012.12.035. Epub 2012 Dec 30.
To review the clinical trial experience with chemotherapy for patients with primary Stage IVB, persistent and recurrent cervical cancer.
PubMed and cooperative group website search was performed and included clinical trials until September 2012. Emphasis was placed on the phase II and III clinical trial experience of the Gynecologic Oncology Group.
Experience and trial results with single agents and combination agents in phase II settings are reviewed. Cisplatin has been considered as the most effective agent for metastatic cervical cancer. Most patients who develop metastatic disease have received cisplatin with concurrent radiation and may no longer be sensitive to single-agent therapy. Therefore, cisplatin-based combination chemotherapy regimens have been extensively studied and eight sentinel phase III trials are discussed in this review.
Based on phase III results, the combination of cisplatin and paclitaxel remains the standard of care; however, alternative combination therapies including cisplatin/topotecan and cisplatin/gemcitabine may be acceptable considerations for patients when considering potential toxicities. Further research is necessary to determine the optimal therapy for this group of patients. Final data from GOG 240 and JCOG 0505 will likely contribute to the design of future clinical trials in this disease setting.
回顾 IVB 期、持续性和复发性宫颈癌患者化疗的临床试验经验。
在 PubMed 和合作组网站上进行了搜索，纳入截至 2012 年 9 月的临床试验。重点是妇科肿瘤学组的 II 期和 III 期临床试验经验。
回顾了 II 期研究中单药和联合用药的经验和试验结果。顺铂被认为是转移性宫颈癌最有效的药物。大多数发生转移性疾病的患者已接受顺铂联合放疗，可能对单药治疗不再敏感。因此，顺铂为基础的联合化疗方案已被广泛研究，本文讨论了八项关键性 III 期试验。
基于 III 期结果，顺铂联合紫杉醇仍然是标准治疗；然而，对于考虑潜在毒性的患者，替代联合治疗方案，包括顺铂/拓扑替康和顺铂/吉西他滨，可能是可以接受的考虑。需要进一步研究以确定这组患者的最佳治疗方法。GOG 240 和 JCOG 0505 的最终数据可能有助于设计该疾病治疗的未来临床试验。
