Gynecologic Oncology Unit, Fodazione IRCCS National Cancer Institute, Via Venezian 1, 20133 Milan, Italy.
Medical Oncology Unit, Oncology Department, Azienda Ospedaliera Treviglio, Piazzale Ospedale 1, 24047 Treviglio, BG, Italy.
Gynecol Oncol. 2014 Apr;133(1):117-23. doi: 10.1016/j.ygyno.2014.01.042. Epub 2014 Jan 31.
The prognosis of advanced/recurrent cervical cancer patients is generally poor with 1-year survival ranging between 15 and 20%. Cisplatin (CDDP) based treatments are considered the most effective regimens; unfortunately toxicity is an issue in a population in which the treatment remains palliative in the finality. Carboplatin (CBDCA), with its more favorable non toxicity profile and the convenience of outpatient administration, may be a suitable alternative to CDDP in combination regimens.
We performed a systematic review of the literature comparing CDDP and CBDCA based chemotherapy for advanced cervical cancer (recurrent, persistent or metastatic disease). Only studies that met the following criteria were considered for the present review: 1) patients treated with CDDP/paclitaxel or CBDCA/paclitaxel combinations as first line chemotherapy for metastatic disease; 2) one or more of the following data available: overall response rate (RR), progression free survival (PFS) or time to progression (TTP), overall survival (OS); 3) single-arm retrospective or prospective study; and 4) at least 20 patients enrolled.
17 eligible studies comprehensive of 1181 patients were included in the final analysis. The objective RR was 48.5% for CBDCA and 49.3% for CDDP-based chemotherapy. Median PFS for CDDP and CBDCA-based treatments was 6.9months and 5months respectively (p=0.03); the corresponding figures for median OS were 12.87 and 10months respectively (p=0.17).
Our study indicates that CBDCA may represent an attractive and valid alternative to the more toxic and equally effective CDDP in the treatment of advanced or recurrent cervical cancer.
晚期/复发性宫颈癌患者的预后一般较差，1 年生存率在 15%至 20%之间。顺铂（CDDP）为基础的治疗被认为是最有效的方案；不幸的是，在治疗最终仍为姑息性的情况下，毒性是一个问题。卡铂（CBDCA）因其毒性谱更有利且门诊管理方便，可能是 CDDP 联合方案的合适替代药物。
我们对比较晚期宫颈癌（复发性、持续性或转移性疾病）中 CDDP 和 CBDCA 为基础的化疗的文献进行了系统评价。只有符合以下标准的研究才被认为符合本综述的要求：1）患者接受 CDDP/紫杉醇或 CBDCA/紫杉醇联合治疗作为转移性疾病的一线化疗；2）有以下数据之一：总缓解率（RR）、无进展生存期（PFS）或进展时间（TTP）、总生存期（OS）；3）单臂回顾性或前瞻性研究；4）至少有 20 名患者入组。
最终分析共纳入 17 项符合条件的研究，包括 1181 名患者。CBDCA 的客观 RR 为 48.5%，CDDP 为 49.3%。CDDP 和 CBDCA 治疗的中位 PFS 分别为 6.9 个月和 5 个月（p=0.03）；中位 OS 分别为 12.87 个月和 10 个月（p=0.17）。
我们的研究表明，在治疗晚期或复发性宫颈癌方面，CBDCA 可能是一种有吸引力且有效的替代 CDDP 的选择，尽管 CDDP 毒性更大，但疗效相当。
