Hirte H, Kennedy E B, Elit L, Fung Kee Fung M
Juravinski Cancer Centre, Hamilton, ON;
Program in Evidence-Based Care, Cancer Care Ontario, McMaster University, Hamilton, ON;
Curr Oncol. 2015 Jun;22(3):211-9. doi: 10.3747/co.22.2447.
Systemic therapy options are needed for women with recurrent, metastatic, or persistent cervical cancer. This systematic review and clinical practice guideline were developed to address that need, and to update a 2007 guideline from Cancer Care Ontario's Program in Evidence-Based Care.
The literature between 2006 and April 2014 in the medline and embase databases, the Cochrane Database of Systematic Reviews (Issue 4, 2014), the Cochrane Central Register of Controlled Trials (Issue 3, 2014), relevant guideline databases, and conference proceedings of the American Society of Clinical Oncology (2007-2013) was searched. A working group developed draft guidelines and incorporated comments and feedback from internal and external reviewers.
Four phase iii randomized controlled trials met the inclusion criteria for the review and provided the basis for draft recommendations. Feedback was obtained from Ontario practitioners and others abroad, which led to modifications to the draft recommendations. Three key recommendations were developed.
The working group concluded that all patients should be offered the opportunity to participate in appropriate randomized clinical trials. Cisplatin-paclitaxel, cisplatin-vinorelbine, cisplatin-gemcitabine, and cisplatin-topotecan are recommended combinations for this patient population. The substitution of carboplatin for cisplatin in the foregoing combinations can also be recommended because carboplatin is associated with fewer adverse effects and greater ease of administration. Selection of combination chemotherapy will depend on the toxicity profile, patient preference, and other factors. Finally, bevacizumab in combination with cisplatin-paclitaxel or carboplatin-paclitaxel is recommended for a specific subset of the target population as outlined in Gynecologic Oncology Group study 0240.
复发性、转移性或持续性宫颈癌女性患者需要系统治疗方案。开展本系统评价和临床实践指南旨在满足这一需求，并更新安大略癌症护理循证护理项目2007年的指南。
检索了2006年至2014年4月期间Medline和Embase数据库、Cochrane系统评价数据库（2014年第4期）、Cochrane对照试验中心注册库（2014年第3期）、相关指南数据库以及美国临床肿瘤学会会议论文集（2007 - 2013年）中的文献。一个工作组制定了指南草案，并纳入了内部和外部评审员的意见和反馈。
四项III期随机对照试验符合该评价的纳入标准，并为推荐草案提供了依据。从安大略省及其他国家的从业者处获得了反馈，这导致对推荐草案进行了修改。制定了三项关键推荐。
工作组得出结论，应向所有患者提供参与适当随机临床试验的机会。顺铂 - 紫杉醇、顺铂 - 长春瑞滨、顺铂 - 吉西他滨和顺铂 - 拓扑替康是推荐用于该患者群体的联合方案。也可推荐在上述联合方案中用卡铂替代顺铂，因为卡铂的不良反应较少且给药更方便。联合化疗方案的选择将取决于毒性特征、患者偏好和其他因素。最后，对于妇科肿瘤学组研究0240中概述的特定目标人群亚组，推荐贝伐单抗联合顺铂 - 紫杉醇或卡铂 - 紫杉醇。
