Unit of Biomedical Research in Cancer, Instituto de Investigaciones Biomedicas UNAM/Instituto Nacional de Cancerologia, Mexico City, Mexico ; ISSEMyM Cancer Center, Toluca, Mexico.
Medical Oncology Service, ABC Medical Center, Mexico City, Mexico.
Int J Womens Health. 2014 Dec 5;6:1023-31. doi: 10.2147/IJWH.S49471. eCollection 2014.
Cervical cancer is the third most commonly diagnosed cancer worldwide and the fourth leading cause of cancer death in women. Major advances but still insufficient achievements in the treatment of locally advanced and high-risk early stage patients have occurred in the last decade with the incorporation of concurrent cisplatin with radiation and, lately, gemcitabine added to cisplatin chemoradiation. Despite a number of clinical studies incorporating molecular-targeted therapy as radiosensitizers being in progress, so far, only antiangiogenic therapy with bevacizumab added to cisplatin chemoradiation has demonstrated safety and shown encouraging results in a Phase II study. In advanced disease, cisplatin doublets do not have a great impact on the natural history of the disease with median survival rates not exceeding 13 months. The first Phase III study of bevacizumab, added to cisplatin or a non-cisplatin-containing doublet, showed significant increase in both overall survival and progression-free survival. Further studies are needed before bevacizumab plus chemotherapy can be considered the standard of care for advanced disease. Characterization of the mutational landscape of cervical cancer has already been initiated, indicating that, for now, few of these targetable alterations match with available agents. Progress in both the mutational landscape knowledge and developments of novel targeted therapies may result in more effective and individualized treatments for cervical cancer. The potential efficacy of knocking down the key alterations in cervical cancer - E6 and E7 human papillomavirus oncoproteins - must not be overlooked.
宫颈癌是全球第三大常见癌症，也是女性癌症死亡的第四大主要原因。在过去十年中，随着顺铂联合放疗的应用，以及最近顺铂联合化疗中添加吉西他滨，局部晚期和高危早期患者的治疗取得了重大进展，但仍未取得足够的成效。尽管有许多包含分子靶向治疗作为放射增敏剂的临床研究正在进行中，但迄今为止，只有抗血管生成治疗贝伐单抗联合顺铂化疗在 II 期研究中显示出安全性和令人鼓舞的结果。在晚期疾病中，顺铂双药治疗对疾病的自然病程没有很大影响，中位生存率不超过 13 个月。贝伐单抗联合顺铂或非顺铂双药的首个 III 期研究显示，总生存期和无进展生存期均显著延长。在贝伐单抗联合化疗可被视为晚期疾病的标准治疗之前，还需要进一步研究。对宫颈癌突变景观的特征描述已经开始，表明目前很少有这些可靶向的改变与现有药物相匹配。在突变景观知识和新型靶向治疗的发展方面取得的进展可能会为宫颈癌提供更有效和个体化的治疗方法。敲除宫颈癌中关键改变——人乳头瘤病毒 E6 和 E7 致癌蛋白——的潜在疗效不容忽视。
