Salvage chemotherapy in recurrent or refractory squamous cell cancer of the uterine cervix.

Squamous cell cancer of the cervix is a relatively drug-resistant tumor. Therefore, chemotherapy is predominantly reserved for cervical cancer patients with recurrent or refractory disease following surgery and/or radiation therapy or for patients who present with far advanced, incurable disease. Objective responses to salvage chemotherapy are generally short lived (4 to 6 months) with few patients surviving more than 1 year. Complete clinical remissions primarily occur at extrapelvic sites (eg, lung, lymph node, and soft tissue metastases). Bulky pelvic tumor in an area of prior irradiation remains largely refractory to further therapy. At present, no chemotherapy regimen has proven superior to single-agent cisplatin, which is associated with an approximately 30% objective response rate. The most effective nonplatinum agents appear to be doxorubicin, ifosfamide, mitolactol, and vincristine. Multiple studies have documented improved partial response rates with platinum-based multiagent chemotherapy, but no regimen has been associated with an improved survival duration. To improve the poor prognosis of this patient group, identification of new agents with at least equivalent activity to cisplatin is mandatory. The development of new platinum-based regimens using currently available agents is unlikely to substantially improve patient survival, although better palliative therapy may result from this approach.