Thigpen T, Vance R, Khansur T, Malamud F
Department of Medicine, University of Mississippi School of Medicine, Jackson 39216, USA.
Semin Oncol. 1997 Feb;24(1 Suppl 2):S2-41-S2-46.
The major role for systemic therapy in the management of carcinoma of the cervix is to treat those patients with advanced or recurrent disease. While 19 single agents have activity, defined as a response rate > or = 15%, the agents that have attracted the greatest attention are the platinum compounds and ifosfamide. Combinations of these two drugs have produced high response rates in phase II trials. A recent randomized trial found that a combination of ifosfamide/cisplatin yielded a superior response rate to cisplatin alone (33% v 19%), although no differences in progression-free or overall survival were observed. While ongoing randomized trials continue to explore platinum/ifosfamide combinations, current attention also is directed to paclitaxel (Taxol; Bristol-Myers Squibb Company, Princeton, NJ), which has demonstrated activity in a phase II trial (18% response rate). The Gynecologic Oncology Group plans to conduct a phase II trial of a platinum/paclitaxel combination and may follow it with a phase III trial of the same combination if the phase II results suggest enhanced therapeutic benefit. Randomized trials in patients with less advanced (stages IIB to IVA) disease have demonstrated superior response rates and overall survival with concomitant chemoradiation. Regimens of demonstrated efficacy in this setting include hydroxyurea plus radiation and cisplatin/5-fluorouracil plus radiation. The Gynecologic Oncology Group currently is conducting a phase I trial of concomitant paclitaxel plus radiation and may consider a paclitaxel-based regimen in future phase III trials of concomitant chemoradiation or possibly neoadjuvant chemotherapy in patients with limited disease (stages IIB to IVA).
全身治疗在宫颈癌管理中的主要作用是治疗那些患有晚期或复发性疾病的患者。虽然有19种单一药物具有活性（定义为缓解率≥15%），但最受关注的药物是铂类化合物和异环磷酰胺。这两种药物的联合在II期试验中产生了高缓解率。最近一项随机试验发现，异环磷酰胺/顺铂联合用药的缓解率优于单独使用顺铂（33%对19%），尽管在无进展生存期或总生存期方面未观察到差异。在正在进行的随机试验继续探索铂/异环磷酰胺联合用药的同时，目前的注意力也转向了紫杉醇（泰素；百时美施贵宝公司，新泽西州普林斯顿），它在一项II期试验中已显示出活性（缓解率为18%）。妇科肿瘤学组计划进行一项铂/紫杉醇联合用药的II期试验，如果II期结果表明有增强的治疗益处，可能随后进行同一联合用药的III期试验。在病情不太严重（IIB至IVA期）的患者中进行的随机试验表明，同步放化疗具有更高的缓解率和总生存期。在这种情况下已证明有效的方案包括羟基脲加放疗和顺铂/5-氟尿嘧啶加放疗。妇科肿瘤学组目前正在进行一项紫杉醇同步放疗的I期试验，并且在未来针对病情有限（IIB至IVA期）患者的同步放化疗或可能的新辅助化疗的III期试验中可能会考虑基于紫杉醇的方案。
