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Gonzalez-Fierro A, Domínguez-Gómez G, Chavez-Blanco A, Duenas-Gonzalez A. Pharmacokinetics and pharmacodynamics of angiogenesis inhibitors used to treat cervical cancer: current and future. Expert Opin Drug Metab Toxicol 2024:1-9. [PMID: 39252168 DOI: 10.1080/17425255.2024.2401586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 09/03/2024] [Indexed: 09/11/2024]
Abstract
INTRODUCTION The treatment of advanced cervical cancer is continuously developing. There is a critical need to explore new treatment options to improve cure rates and make treatment more affordable. Despite efforts in prevention, cervical cancer remains the fourth most common cancer worldwide in terms of both incidence and mortality. AREAS COVERED This article offers an updated and critical analysis of angiogenesis inhibitors used in the treatment of advanced cervical cancer. It should be noted that this is not a systematic review. EXPERT OPINION Bevacizumab is currently the primary antiangiogenic agent used alongside chemotherapy and has become the standard of care for advanced cervical cancer. However, there are still uncertainties regarding the molecular mechanisms and associations in cervical cancer that could help in optimizing the use of Bevacizumab. Factors such as cost, toxicity, and methodological issues in the GOG-240 trial must be considered.
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Affiliation(s)
- Aurora Gonzalez-Fierro
- Subdireccion de Investigacion Basica, Instituto Nacional de Cancerologia, Mexico City, Mexico
| | | | - Alma Chavez-Blanco
- Subdireccion de Investigacion Basica, Instituto Nacional de Cancerologia, Mexico City, Mexico
| | - Alfonso Duenas-Gonzalez
- Subdireccion de Investigacion Basica, Instituto Nacional de Cancerologia, Mexico City, Mexico
- Departamento de Medicina Genomica y Toxicología Ambiental, Instituto de Investigaciones Biomedicas, Universidad Nacional Autonoma de Mexico, Mexico City, Mexico
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2
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Yang ST, Wang PH, Liu HH, Chang CW, Chang WH, Lee WL. Cervical cancer: Part II the landscape of treatment for persistent, recurrent and metastatic diseases (I). Taiwan J Obstet Gynecol 2024; 63:637-650. [PMID: 39266144 DOI: 10.1016/j.tjog.2024.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2024] [Indexed: 09/14/2024] Open
Abstract
The WHO (World Health Organization) conducted an elimination of cervical cancer program using triple pillar intervention strategy to target 90%-70%-90% of women before the year 2030, including (1) a full vaccination of HPV (human papillomavirus) vaccine to 90% of girls <15 years of age; (2) a high-performance screening procedure to 70% of women during the reproductive age (at the age of 35 and 45 years of age); and (3) an appropriate and adequate treatment to 90% of women with confirmed diagnosis of cervical lesions. Among the aforementioned three pillars, a full HPV vaccination has been introduced in our previous review, of which we have discussed the policy and strategy of HPV vaccination in the world and also reviewed the efficacy of HPV vaccination, with a successful reduction of over 90% of HPV-associated neoplasms. The aims of the current review will target another pillar-an appropriate and adequate treatment to 90% of women with confirmed diagnosis of cervical lesions. Since the early-stage cervical cancer has a favorable outcome and the treatment recommendation has been established, therefore, the current review focuses on women with persistent, recurrent and metastatic cervical cancers (advanced cervical cancers), which are still a biggest challenge based on its extremely worse outcomes before the introduction of immune checkpoint inhibitors (ICIs). Integration of ICIs into conventional chemotherapy (paclitaxel-cisplatin) has become the new standard therapy for those patients with advanced cervical cancers. The recent clinical trials, such as KENOTE 826 and KENOTE A18 showing a dramatical improvement of both progression free survival and overall survival have approved the therapeutic efficacy of this combination as ICI plus paclitaxel-platinum (cisplatin or carboplatin) with/without bevacizumab to women with persistent, recurrent and metastatic cervical cancers.
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Affiliation(s)
- Szu-Ting Yang
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Peng-Hui Wang
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Female Cancer Foundation, Taipei, Taiwan; Department of Medical Research, China Medical University Hospital, Taichung, Taiwan.
| | - Hung-Hsien Liu
- Department of Medical Imaging and Intervention, Tucheng Hospital, New Taipei City, Taiwan
| | - Che-Wei Chang
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wen-Hsun Chang
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wen-Ling Lee
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Medicine, Cheng-Hsin General Hospital, Taipei, Taiwan.
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Duska LR, Podwika SE, Randall LM. Top advances of the year: Cervical cancer. Cancer 2024; 130:2571-2576. [PMID: 38651760 DOI: 10.1002/cncr.35334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
The year 2023 was an extraordinary year for the further development and expansion of novel treatments for all patients with cervical cancer, ranging from early stage to later stage and metastatic or recurrent disease. Individuals with early-stage disease will benefit from less invasive surgery with subsequent improvement in quality of life. The effectiveness of immunotherapy has been demonstrated in upfront, locally advanced cervical cancer and confirmed in advanced metastatic disease. Induction chemotherapy will play a role in some patients with locally advanced disease, particularly those in low resource areas of the world. Novel therapeutics including antibody-drug conjugates have shown efficacy even in pretreated patients. As we continue to explore innovative therapeutics in this space, however, we must also continue to improve the diversity of clinical trial accrual to allow for generalizable results. At the same time, we must focus on eradicating this disease with appropriate screening and vaccination.
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Affiliation(s)
- Linda R Duska
- University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Sarah E Podwika
- University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Leslie M Randall
- Massey Comprehensive Cancer Center, VCUHealth, Richmond, Virginia, USA
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Sarwar F, Ashhad S, Vimal A, Vishvakarma R. Small molecule inhibitors of the VEGF and tyrosine kinase for the treatment of cervical cancer. Med Oncol 2024; 41:199. [PMID: 38985225 DOI: 10.1007/s12032-024-02446-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 07/02/2024] [Indexed: 07/11/2024]
Abstract
Cervical cancer accounts for most deaths due to cancer in women, majorly in developing nations. The culprit behind this disease is the human papillomavirus (HPV) which accounts for more than 90% of cervical cancer cases. The viral strains produce proteins that favor the knocking down of the apoptosis process and continuous growth of cells in the cervix leading to tumor growth. Proangiogenic growth factors, such as fibroblast growth factor (FGF), vascular endothelial growth factor (VEGF), angiopoietins, and other endothelial growth factors (EGF), are secreted by tumor cells and the surrounding microenvironment, which further advances the development of cancer. The extracellular domain of receptor tyrosine kinases is employed by ligands (like VEGF and EGF) to engage and activate them by inducing receptor dimerization, which facilitates the cascade impact of these factors. The tyrosine kinase domains of each receptor autophosphorylate each other, activating the receptor and initiating signaling cascades that promote angiogenesis, migration, proliferation, and survival of endothelial cells. Cancer cells benefit from its modified signaling pathways, which cause oncogenic activation. Upon early cervical cancer detection, the second-line therapy strategy involves blocking the signaling pathways with VEGF and small molecule tyrosine kinase inhibitors (TKIs). This review paper highlights the genesis of cervical cancer and combating it using VEGF and tyrosine kinase inhibitors by delving into the details of the currently available inhibitors. Further, we have discussed the inhibitor molecules that are currently in various phases of clinical trials. This paper will surely enhance the understanding of cervical cancer and its treatment approaches and what further interventions can be done to alleviate the disease currently serving as a major health burden in the developing world.
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Affiliation(s)
- Fatima Sarwar
- Department of Bioengineering, Integral University, Lucknow, Uttar Pradesh, 226026, India
| | - Samreen Ashhad
- Department of Bioengineering, Integral University, Lucknow, Uttar Pradesh, 226026, India
| | - Archana Vimal
- Department of Bioengineering, Integral University, Lucknow, Uttar Pradesh, 226026, India.
| | - Reena Vishvakarma
- Department of Bioengineering, Integral University, Lucknow, Uttar Pradesh, 226026, India.
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Kumar M, Baruah U, Begum D, Barmon D, Nath J, Khanikar D, Bassetty KC. To study the survival outcomes of uncommon recurrences among patients with cervical cancer compared with loco-regional and nodal recurrences at a tertiary care center in North East India - Bridging the knowledge gap in the existing literature. Eur J Obstet Gynecol Reprod Biol X 2024; 22:100314. [PMID: 38770162 PMCID: PMC11103416 DOI: 10.1016/j.eurox.2024.100314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 01/08/2024] [Accepted: 05/05/2024] [Indexed: 05/22/2024] Open
Abstract
Background Recurrence rates of FIGO stage IB-IIA and IIB-IVA cervical cancer 28-64 respectively. There is a scarcity of data on the recurrence recurrence pattern for unusual sites and theirrecurrence pattern for unusual sites and its association with survival and prognosis. Objective To study overall survival in patients with distant metastasis compared to local and regional nodal metastasis. Methods A retrospective study was done from 1/1/2017 to 30/12/22. Cervical cancer patients post primary treatments were included. Survival was analyzed with respect to 3 groups local, regional nodalconducted from 1/1/2017 to 30/12/22. Cervical cancer patients who had received primary post-primary treatments were included. Survival was analyzed with respect to three groups: local, regional nodal, and distant metastasis. Results 225 patients had recurrences post-completion of primary treatment, of which 105 (46.6%)(46.6 %) had local, 46 (20.4%)(20.4 %) had regional nodal, and 74 (33.3 %) had distant recurrences. The median time for recurrence in local, regional nodal, and atypical recurrences were 9, 9, and 13 months (p value - <0.05), respectively. Treatment included systemic chemotherapy 122 (54.2 %), metronomic therapy 19 (8.4 %), palliative radiotherapy 44 (19.5 %), palliative surgery 8 (3.5 %) and best supportive care 30 (13.3 %) patients. Median Time to treatment-death of patients after recurrence in local, nodal and distant recurrences was 17.0 months, 18.0 months and 10.0 months respectively (p value - < 0.05). Overall Survival of patients after primary treatment with local, nodal and distant recurrences was 35.0 months, 47.0 months and 50.0 months respectively (p value <0.05). Conclusion Local recurrence is most common, followed by regional, nodal, and distant recurrences. Overall survival post recurrence was lowest for distant recurrences and highest for local recurrences however overall survival after primary treatment completion was highest for distant recurrence due to the late presen; however, tation of distant recurrences.
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Affiliation(s)
- Mahendra Kumar
- Department of gynaecological oncology, Dr B Borooah cancer Institute, Guwahati, Assam, India
| | - Upasana Baruah
- Department of gynaecological oncology, Dr B Borooah cancer Institute, Guwahati, Assam, India
| | - Dimpy Begum
- Department of gynaecological oncology, Dr B Borooah cancer Institute, Guwahati, Assam, India
| | - Debabrata Barmon
- Department of gynaecological oncology, Dr B Borooah cancer Institute, Guwahati, Assam, India
| | - Jyotiman Nath
- Department of Radiation oncology, Dr. Bhubaneswar Borooah cancer institute, Guwahati, Assam, India
| | - Duncan Khanikar
- Department of Medical oncology, Dr. Bhubaneswar Borooah cancer institute, Guwahati, Assam, India
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Sitler CA, Tian C, Hamilton CA, Richardson MT, Chan JK, Kapp DS, Leath CA, Casablanca Y, Washington C, Chappell NP, Klopp AH, Shriver CD, Tarney CM, Bateman NW, Conrads TP, Maxwell GL, Phippen NT, Darcy KM. Immuno-Molecular Targeted Therapy Use and Survival Benefit in Patients with Stage IVB Cervical Carcinoma in Commission on Cancer ®-Accredited Facilities in the United States. Cancers (Basel) 2024; 16:1071. [PMID: 38473428 DOI: 10.3390/cancers16051071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 02/27/2024] [Accepted: 03/03/2024] [Indexed: 03/14/2024] Open
Abstract
PURPOSE To investigate IMT use and survival in real-world stage IVB cervical cancer patients outside randomized clinical trials. METHODS Patients diagnosed with stage IVB cervical cancer during 2013-2019 in the National Cancer Database and treated with chemotherapy (CT) ± external beam radiation (EBRT) ± intracavitary brachytherapy (ICBT) ± IMT were studied. The adjusted hazard ratio (AHR) and 95% confidence interval (CI) for risk of death were estimated in patients treated with vs. without IMT after applying propensity score analysis to balance the clinical covariates. RESULTS There were 3164 evaluable patients, including 969 (31%) who were treated with IMT. The use of IMT increased from 11% in 2013 to 46% in 2019. Age, insurance, facility type, sites of distant metastasis, and type of first-line treatment were independently associated with using IMT. In propensity-score-balanced patients, the median survival was 18.6 vs. 13.1 months for with vs. without IMT (p < 0.001). The AHR was 0.72 (95% CI = 0.64-0.80) for adding IMT overall, 0.72 for IMT + CT, 0.66 for IMT + CT + EBRT, and 0.69 for IMT + CT + EBRT + ICBT. IMT-associated survival improvements were suggested in all subgroups by age, race/ethnicity, comorbidity score, facility type, tumor grade, tumor size, and site of metastasis. CONCLUSIONS IMT was associated with a consistent survival benefit in real-world patients with stage IVB cervical cancer.
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Affiliation(s)
- Collin A Sitler
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
| | - Chunqiao Tian
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Bethesda, MD 20817, USA
| | - Chad A Hamilton
- Gynecologic Oncology Section, Women's Services and The Ochsner Cancer Institute, Ochsner Health, New Orleans, LA 70115, USA
| | - Michael T Richardson
- Department of Obstetrics and Gynecology, Los Angeles School of Medicine, University of California, Los Angeles, CA 90024, USA
| | - John K Chan
- Palo Alto Medical Foundation, California Pacific Medical Center, Sutter Health, San Francisco, CA 94010, USA
| | - Daniel S Kapp
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Charles A Leath
- Division of Gynecologic Oncology, University of Alabama at Birmingham, O'Neal Comprehensive Cancer Center, Birmingham, AL 35249, USA
| | - Yovanni Casablanca
- Gynecologic Oncology Division, Levine Cancer Institute, Atrium Health, Charlotte, NC 28204, USA
| | - Christina Washington
- Gynecologic Oncology Division, Stephenson Cancer Center, Oklahoma University Health Sciences Center, Oklahoma City, OK 73104, USA
| | - Nicole P Chappell
- Gynecologic Oncology Division, GW Medical Faculty Associates, George Washington University, Washington, DC 20037, USA
| | - Ann H Klopp
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Craig D Shriver
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
| | - Christopher M Tarney
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
| | - Nicholas W Bateman
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Bethesda, MD 20817, USA
| | - Thomas P Conrads
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
- Women's Health Integrated Research Center, Women's Service Line, Inova Health System, Falls Church, VA 22042, USA
| | - George Larry Maxwell
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
- Women's Health Integrated Research Center, Women's Service Line, Inova Health System, Falls Church, VA 22042, USA
| | - Neil T Phippen
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
| | - Kathleen M Darcy
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Bethesda, MD 20817, USA
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Garcia-Sayre J, Lin YG, Matuso K, Tsao-Wei DD, Mhawech-Fauceglia P, Louie S, Dong T, Ciccone MA, Brunette-Masi LL, Pham HQ, Yessaian AA, Groshen SG, Facio G, Aldana M, Muderspach LI, Garcia AA, Roman LD. Two staged phase II clinical trial of Eribulin monotherapy in advanced or recurrent cervical cancer. Gynecol Oncol 2023; 173:49-57. [PMID: 37079977 DOI: 10.1016/j.ygyno.2023.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 02/22/2023] [Accepted: 02/25/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND Eribulin a microtubule targeting agent and analog of Halichondrin B, a natural product isolated from marine sponge H. okadai, has proven clinical efficacy in metastatic pretreated breast cancer and liposarcoma. We conducted a 2-stage Phase II study of eribulin in patients with advanced/recurrent cervical cancer to examine its clinical activity and evaluate biomarkers for predictors of response. METHODS Women with advanced/recurrent cervical cancer after ≤1 prior chemotherapy regimen, measurable disease and ECOG performance status ≤2 were treated with eribulin (1.4 mg/m2 IV day 1 and 8, every 21 days) with tumor assessments every 2 cycles. Primary endpoint was 6-month progression-free survival (PFS6); secondary were best overall response (RECISTv1.1), toxicity (CTCAEv4.03) and overall survival (OS). Exploratory endpoints were associations of biomarkers with clinical activity. Immunohistochemistry was performed on archival tumor samples. Overexpression was defined when both intensity and distribution scores were ≥ 2. RESULTS 32 patients enrolled from 11/2012-5/2017. 29/32 patients had prior chemotherapy with cisplatin/paclitaxel/bevacizumab (n = 12) or cisplatin/gemcitabine (n = 12) as the most common regimens. 14 patients received prior paclitaxel. 1 (3%) had a complete response, 5 (16%) had a partial response and 13 (41%) had stable disease for ORR of 19% (95% CI 8, 37). Those who are paclitaxel naïve experienced the greatest benefit with a 29% ORR (95% CI 12, 54). Patients who received prior paclitaxel responded less favorably than those who did not (p = .002) and had a shorter PFS and OS. Grade 3/4 adverse events occurring in >10% of patients were anemia (n = 12, 38%), neutropenia (n = 7, 22%) and leukopenia (n = 6, 19%). Analysis of correlative predictors of response revealed that patients who did not overexpress βII and BAX were significantly more likely to respond to e`ribulin. PFS was significantly shorter in patients with βII and BAX overexpression, OS was significantly shorter in those with βIII and BAX overexpression. These associations remained after multivariate analysis. CONCLUSIONS Eribulin shows modest activity in patients with recurrent/advanced cervical cancer with a favorable toxicity profile. Prior paclitaxel exposure is associated with decreased eribulin response. βII, βIII tubulin subtypes and BAX are predictors of response and survival. Eribulin may be an option for women with paclitaxel-naïve recurrent/advanced cervical cancer.
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Affiliation(s)
- Jocelyn Garcia-Sayre
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, United States of America.
| | - Yvonne G Lin
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, United States of America
| | - Koji Matuso
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, United States of America
| | - Denice D Tsao-Wei
- Department of Preventive Medicine, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, United States of America
| | | | - Stan Louie
- University of Southern California School of Pharmacy, Los Angeles, CA, United States of America
| | - Tiange Dong
- University of Southern California School of Pharmacy, Los Angeles, CA, United States of America
| | - Marcia A Ciccone
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, United States of America
| | - Laurie L Brunette-Masi
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, United States of America
| | - Huyen Q Pham
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, United States of America
| | - Annie A Yessaian
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, United States of America
| | - Susan G Groshen
- Department of Preventive Medicine, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, United States of America
| | - Grace Facio
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, United States of America
| | - Marissa Aldana
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, United States of America
| | - Laila I Muderspach
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, United States of America
| | - Agustin A Garcia
- Division of Hematology Oncology, Department of Internal Medicine, Louisiana State University, New Orleans, LA, United States of America
| | - Lynda D Roman
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, United States of America
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Ishikawa M, Shibata T, Kataoka T, Takekuma M, Kobayashi H, Yaegashi N, Satoh T. Final analysis of a randomized phase II/III trial of conventional paclitaxel and carboplatin with or without bevacizumab versus dose-dense paclitaxel and carboplatin with or without bevacizumab, in stage IVB, recurrent, or persistent cervical carcinoma (JCOG1311). Int J Gynecol Cancer 2023; 33:692-700. [PMID: 36997229 DOI: 10.1136/ijgc-2022-004214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2023] Open
Abstract
OBJECTIVE To assess the efficacy of dose-dense weekly paclitaxel plus carboplatin in metastatic or recurrent cervical carcinoma, we conducted a phase II/III randomized controlled study comparing dose-dense paclitaxel and carboplatin with or without bevacizumab to conventional paclitaxel and carboplatin with or without bevacizumab. However, at the primary analysis of the phase II part, the response rate in the dose-dense arm was not higher than in the conventional arm and the study was terminated early before starting phase III. After a further 2 years of follow-up, we conducted this final analysis. METHODS 122 patients were enrolled and randomly assigned to either the conventional or dose-dense arm. After bevacizumab was approved in Japan, patients in both arms received bevacizumab if not contraindicated. In the final analysis, overall survival, progression-free survival, and adverse events were updated. RESULTS The median follow-up of surviving patients was 34.8 months (range 19.2-64.8). Median overall survival in the conventional arm was 17.7 months and in the dose-dense arm 18.5 months (p=0.71). Median progression-free survival in the conventional arm was 7.9 months and in the dose-dense arm 7.2 months (p=0.64). A platinum-free interval within 24 weeks and treatment without bevacizumab were identified as prognostic factors for overall and progression-free survival. Grade 3 to 4 non-hematologic toxicity occurred in 46.7% of patients who received the conventional regimen and in 43.3% of patients who received the dose-dense regimen. Adverse events related to bevacizumab in 82 patients included fistula in five (6.1%) and gastrointestinal perforation in three (3.7%). CONCLUSIONS It was confirmed that dose-dense paclitaxel plus carboplatin for metastatic or recurrent cervical carcinoma is not superior to conventional paclitaxel and carboplatin. Patients who had early refractory disease after prior chemoradiotherapy had the poorest prognosis. The development of treatments that improve the prognosis of such patients remains an important issue. CLINICAL TRIAL INFORMATION jRCTs031180007.
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Affiliation(s)
- Mitsuya Ishikawa
- Department of Gynecology, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
| | - Taro Shibata
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
| | - Tomoko Kataoka
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
| | - Munetaka Takekuma
- Division of Gynecology, Shizuoka Cancer Center Hospital, Sunto-gun, Shizuoka, Japan
| | - Hiroaki Kobayashi
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kagoshima University, Kagoshima, Kagoshima, Japan
| | - Nobuo Yaegashi
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Toyomi Satoh
- Obstetrics and Gynecology, University of Tsukuba, Tsukuba, Japan
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9
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Paulino E, de Melo AC, de Andrade DAP, de Almeida MS. Systemic therapy for advanced cervical cancer: Leveraging the historical threshold of overall survival. Crit Rev Oncol Hematol 2023; 183:103925. [PMID: 36696932 DOI: 10.1016/j.critrevonc.2023.103925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 12/27/2022] [Accepted: 01/20/2023] [Indexed: 01/23/2023] Open
Abstract
Cervical cancer (CC) is a worldwide problem, especially in low- and middle-income countries, where patients are often diagnosed with locally advanced disease. Until recently, all chemotherapy drugs achieved low ORR and 12-month overall survival (12- month OS) for advanced CC after failure for platinum compounds. Advances in systemic therapy with immunotherapy, targeted therapy, and antibody-drug conjugates (ADC) have leveraged the 12-month OS limit. Recently, immunotherapy (pembrolizumab) has become the standard of care in first-line advanced CC combined with platinum and taxane and in second-line after platinum doublet failure.
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Affiliation(s)
- Eduardo Paulino
- Brazilian National Cancer Institute, Rio de Janeiro, Brazil; Oncologia D'or, Rio de Janeiro, Brazil.
| | - Andreia Cristina de Melo
- Brazilian National Cancer Institute, Rio de Janeiro, Brazil; Grupo Oncoclínicas, Rio de Janeiro, Brazil
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An J, Tang J, Li BX, Xiong H, Qiu H, Luo L, Wang L, Wang D, Zhou Q, Xu Q, Song H, Zhang Y, Zhang H, Li Y, Yu X, Zhang J, Ng R, Zhao W, Wong M, Dai X, Li G, Wu L. Efficacy and Safety of the Anti-PD-L1 mAb Socazolimab for Recurrent or Metastatic Cervical Cancer: a Phase I Dose-Escalation and Expansion Study. Clin Cancer Res 2022; 28:5098-5106. [PMID: 36136294 DOI: 10.1158/1078-0432.ccr-22-1280] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 06/27/2022] [Accepted: 09/20/2022] [Indexed: 01/24/2023]
Abstract
PURPOSE This study (ClinicalTrials.gov identifier, NCT03676959) is an open, phase I dose-escalation and expansion study investigating the safety and efficacy of the recombinant, fully human anti-programmed death ligand 1 (PD-L1) mAb socazolimab in patients diagnosed with recurrent or metastatic cervical cancer. PATIENTS AND METHODS Patients received socazolimab every 2 weeks until disease progression. The study was divided into a dose-escalation phase and a dose-expansion phase. Safety and tolerability were primary endpoints of the dose-escalation phase. The primary endpoints of the dose-expansion phase were safety and the objective response rate (ORR) of the 5 mg/kg dose. Efficacy was assessed by the third-party independent review committee (IRC) using the Response Evaluation Criteria in Solid Tumors version 1.1 (RECIST 1.1). RESULTS 104 patients were successfully enrolled into the study. Twelve patients were included in the dose-escalation phase, with one complete response and two partial responses in the 5 mg/kg treatment group. Ninety-two patients (5 mg/kg) were enrolled in the dose-expansion phase. Fifty-four patients (59.3%) had baseline PD-L1-positive tumor expression (combined positive score ≥1). ORR was 15.4% [95% confidence interval (CI), 8.7%-24.5%]. Median PFS was 4.44 months (95% CI, 2.37-5.75 months), and the median OS was 14.72 months (95% CI, 9.59-NE months). ORR of PD-L1-positive patients was 16.7%, and the ORR of PD-L1-negative patients was 17.9%. No treatment-related deaths occurred. CONCLUSIONS Our study demonstrates that socazolimab has durable safety and efficacy for the treatment of recurrent or metastatic cervical cancer and exhibits a safety profile similar to other anti-PD-1/PD-L1 mAbs.
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Affiliation(s)
- Jusheng An
- Department of Gynecologic Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jie Tang
- Hunan Tumor Hospital, Hunan, China
| | - Benjamin X Li
- Lee's Pharmaceutical Holdings Limited, Hong Kong SAR
| | - Huihua Xiong
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hui Qiu
- Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Lin Luo
- Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Li Wang
- Henan Cancer Hospital, Henan, China
| | - Danbo Wang
- Liaoning Cancer Hospital, Liaoning, China
| | - Qi Zhou
- Chongqing Cancer Hospital, Chongqing, China
| | - Qin Xu
- Fujian Cancer Hospital, Fujian, China
| | - Honglin Song
- Affiliated Tumor Hospital of Guangxi Medical University, Guangxi, China
| | - Yunyan Zhang
- Affiliated Tumor Hospital of Harbin Medical University, Heilongjiang, China
| | | | - Yujie Li
- Lee's Pharmaceutical Holdings Limited, Hong Kong SAR
| | - Xiaohui Yu
- Lee's Pharmaceutical Holdings Limited, Hong Kong SAR
| | - Jing Zhang
- Lee's Pharmaceutical Holdings Limited, Hong Kong SAR
| | - Rachel Ng
- Lee's Pharmaceutical Holdings Limited, Hong Kong SAR
| | - Wayne Zhao
- Lee's Pharmaceutical Holdings Limited, Hong Kong SAR
| | - Michael Wong
- Lee's Pharmaceutical Holdings Limited, Hong Kong SAR
| | - Xiangrong Dai
- Lee's Pharmaceutical Holdings Limited, Hong Kong SAR
| | - Guiling Li
- Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lingying Wu
- Department of Gynecologic Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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11
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Gennigens C, Jerusalem G, Lapaille L, De Cuypere M, Streel S, Kridelka F, Ray-Coquard I. Recurrent or primary metastatic cervical cancer: current and future treatments. ESMO Open 2022; 7:100579. [PMID: 36108558 PMCID: PMC9588874 DOI: 10.1016/j.esmoop.2022.100579] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 07/19/2022] [Accepted: 08/12/2022] [Indexed: 11/12/2022] Open
Abstract
Despite screening programs for early detection and the approval of human papillomavirus vaccines, around 6% of women with cervical cancer (CC) are discovered with primary metastatic disease. Moreover, one-third of the patients receiving chemoradiation followed by brachytherapy for locally advanced disease will have a recurrence. At the end, the vast majority of recurrent or metastatic CC not amenable to locoregional treatments are considered incurable disease with very poor prognosis. Historically, cisplatin monotherapy, then a combination of cisplatin and paclitaxel were considered the standard of care. Ten years ago, the addition of bevacizumab to chemotherapy demonstrated favorable data in terms of response rate and overall survival. Even with this improvement, novel therapies are needed for the treatment of recurrent CC in first as well as later lines. In the last decades, a better understanding of the interactions between human papillomavirus infection and the host immune system response has focused interest on the use of immunotherapeutic drugs in CC patients. Indeed, immune checkpoint inhibitors (pembrolizumab, cemiplimab, and others) have recently emerged as novel therapeutic pillars that could provide durable responses with impact on overall survival in patients in the primary (in addition to chemotherapy) or recurrent (monotherapy) settings. Tisotumab vedotin, an antibody-drug conjugate targeting the tissue factor, is another emerging drug. Several trials in monotherapy or in combination with immunotherapy, chemotherapy, or bevacizumab showed very promising results. There is a high need for more potent biomarkers to better accurately determine which patients would receive the greatest benefit from all these aforementioned drugs, but also to identify patients with specific molecular characteristics that could benefit from other targeted therapies. The Cancer Genome Atlas Research Network identified several genes significantly mutated, potentially targetable. These molecular data have highlighted the molecular heterogeneity of CC.
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Affiliation(s)
- C Gennigens
- Department of Medical Oncology, CHU Liège, Liège, Belgium.
| | - G Jerusalem
- Department of Medical Oncology, CHU Liège, Liège, Belgium; Faculty of Medicine, University of Liège, Liège, Belgium
| | - L Lapaille
- Department of Medical Oncology, CHU Liège, Liège, Belgium
| | - M De Cuypere
- Department of Obstetrics and Gynaecology, CHU Liège, Liège, Belgium
| | - S Streel
- Department of Medical Oncology, CHU Liège, Liège, Belgium
| | - F Kridelka
- Faculty of Medicine, University of Liège, Liège, Belgium; Department of Obstetrics and Gynaecology, CHU Liège, Liège, Belgium
| | - I Ray-Coquard
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France
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12
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Qi L, Li N, Lin A, Wang X, Cong J. Efficacy and safety of pembrolizumab on cervical cancer: A systematic review and single-arm meta-analysis. Front Oncol 2022; 12:910486. [PMID: 36033480 PMCID: PMC9399507 DOI: 10.3389/fonc.2022.910486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 07/15/2022] [Indexed: 11/23/2022] Open
Abstract
Background According to current research, the objective response rate and overall survival of pembrolizumab in the treatment of several types of solid tumors have been significantly improved. Some high-quality clinical trials have studied the effect of applying pembrolizumab in treating cervical cancer. Multiple clinical trials have been conducted, and some of them have shown good results as expected. Therefore, we performed this meta-analysis on existing studies to reveal the efficacy and safety of pembrolizumab in treating cervical cancer. Methods PubMed, Embase, Cochrane Library and Web of Science were searched for literatures published until October 31, 2021. Outcomes included complete response (CR), partial response (PR), stable disease (SD), disease progression (PD), objective response rate (ORR), disease control rate (DCR), overall survival (OS), progression-free survival (PFS), the best time to response (TTR), death rate, adverse events (AE). Results A total of 7 studies with 727 patients were included. The results were as follows: CR (0.027, 95%CI: 0.008-0.053), PR (0.104, 95% CI: 0.074-0.145), SD (0.190, 95% CI: 0.149-0.240), PD (0.541, 95% CI: 0.421-0.661). ORR was 0.155 (95% CI: 0.098-0.236) and DCR was 0.331 (95% CI: 0.277-0.385). OS was 10.23 months (95% CI: 8.96-11.50) and PFS was 4.27 months (95% CI: 1.57-6.96). TTR was 2.10 months (95%CI: 1.69-2.51). The 1-year death rate was 0.388 (95% CI: 0.230-0.574). Main adverse events included abnormal liver function, hypothyroidism, neutropenia, anemia, decreased appetite, fatigue, fever, etc. The total incidence of the adverse events of grade 3 and above was 0.212 (95% CI: 0.065-0.509). Conclusions Pembrolizumab provides significant benefits in response rate and survival for cervical cancer patients. The results from recent high-quality clinical trials are expected to validate these findings. Systematic Review Registration https://www.crd.york.ac.uk/prospero/, identifier CRD42021291723.
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Affiliation(s)
- Lin Qi
- *Correspondence: Jianglin Cong, ; Lin Qi,
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13
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Pelvic bones ADC could help to predict severe hematologic toxicity in patients undergoing concurrent chemoradiotherapy for cervical cancer. Magn Reson Imaging 2022; 94:98-104. [PMID: 35777686 DOI: 10.1016/j.mri.2022.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 06/15/2022] [Accepted: 06/22/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Hematologic toxicity (HT) during concurrent chemoradiotherapy (CCRT) for cervical cancer can lead to treatment breaks and compromise efficacy. PURPOSE To evaluate the association between severe hematologic toxicity (HT) and clinical factors and pelvic apparent diffusion coefficient (ADC) during CCRT of cervical cancer patients. METHODS Data from 120 patients with cervical cancer who were treated with CCRT from January 2016 and December 2018 were retrospectively analyzed. The clinical data (age, menopausal status, clinical stage, body mass index, chemotherapy regimen and chemotherapy cycle) of the patients were collected, and the cohort were divided into two groups based on the HT grade: HT3+ group (HT grade ≥ 3; 66 patients) and HT3- group (HT grade<3; 54 patients). All patients performed MRI before CCRT, and pelvic (ilium, pubis, ischium) ADC value was measured on ADC map. The correlation between severe HT and clinical parameters and pelvic ADC value were analyzed by univariate analysis, and the diagnostic performance was further assessed by receiver operating characteristic (ROC) analysis. RESULTS In univariate analysis, the menopausal status (p = 0.012) and chemotherapy regimen (p = 0.011) were significantly correlated with severe HT in overall patients, and menopausal patients or patients receiving paclitaxel plus cisplatin (TP) regimen were more likely to develop severe HT. HT3+ group showed a significantly lower pelvic ADC value than HT3- group. The ADC value cut-offs derived from our study for predicting severe HT was 0.317 × 10-3 mm2/s in overall patients. Neither clinical parameters or pelvic ADCs were associated with severe HT in menopausal patients when analyzed separately (p > 0.05). CONCLUSIONS Severe HT was significantly associated with menopausal status and chemotherapy regimen in patients with cervical cancer treated with CCRT, and HT3+ group showed a lower pelvic ADC value.
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Katke A, Nanda R, Thejaswini B, Pasha T, Giri GV, Babu G, Pawar Y. Weekly vs. tri-weekly cisplatin based chemoradiation in carcinoma cervix: a prospective randomized study of toxicity and compliance. Rep Pract Oncol Radiother 2021; 26:948-954. [PMID: 34992867 PMCID: PMC8726454 DOI: 10.5603/rpor.a2021.0115] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 10/28/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Addition of chemotherapy to radiation has improved 5-year survival by 6%. However, the optimal dose and schedule of concurrent cisplatin is not well defined, though widely accepted practice is the weekly schedule of 40 mg/m2 for 5 weeks. Repeated admissions for weekly cisplatin drain the limited resources in high volume centres. We intended to study the compliance and toxicity of two cisplatin schedules in our patients diagnosed with carcinoma cervix. MATERIALS AND METHODS Between 2007-2011, 212 patients, histologically proven squamous cell carcinoma with stages IIB to IIIB were randomized into two arms. All patients were planned for external beam radiotherapy 45 Gy/25 frs over 5 weeks followed by Intracavitary or Interstitial brachytherapy to a total BED dose of 75-85 Gy. Single agent cisplatin given concomitantly, was scheduled weekly (40 mg/m2/cycle, 5 cycles) in an arm A and three weekly (100 mg/m2/cycle, 2 cycles) in an arm B. Toxicity and compliance were evaluated weekly according to the RTOG guidelines. Analysis of the compiled data was done using SSPS version 20. RESULTS Of the evaluable 212, 109 patients received weekly cisplatin chemotherapy and 103 patients received three weekly cisplatin. The most common acute toxicity observed was grade I-II leucopoenia. The upper and lower gastrointestinal reactions were high in three weekly arms, which was statistically significant (57% and 42.7%, p < 0.05). Proctitis was observed in 10% of patients in both of the arms and only two patients had Gr1 Cystitis after 6 months of treatment. CONCLUSIONS Tri-weekly cisplatin based concurrent chemoradiation can be adopted in high volume centres with manageable haematological and gastrointestinal acute toxicities.
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Affiliation(s)
- Aradhana Katke
- Department of Radiation Oncology, Kidwai Memorial Institute of Oncology, Bangalore, India
| | - R Nanda
- Department of Radiation Oncology, Kidwai Memorial Institute of Oncology, Bangalore, India
| | - B Thejaswini
- Department of Radiation Oncology, Kidwai Memorial Institute of Oncology, Bangalore, India
| | - Tanveer Pasha
- Department of Radiation Oncology, Kidwai Memorial Institute of Oncology, Bangalore, India
| | - G V Giri
- Department of Radiation Oncology, Kidwai Memorial Institute of Oncology, Bangalore, India
| | - Govind Babu
- Department of Radiation Oncology, Kidwai Memorial Institute of Oncology, Bangalore, India
| | - Yashwant Pawar
- Department of Radiation Oncology, Kidwai Memorial Institute of Oncology, Bangalore, India
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Gopu P, Antony F, Cyriac S, Karakasis K, Oza AM. Updates on systemic therapy for cervical cancer. Indian J Med Res 2021; 154:293-302. [PMID: 35295013 PMCID: PMC9131767 DOI: 10.4103/ijmr.ijmr_4454_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Indexed: 11/15/2022] Open
Abstract
Cervical cancer is one of the most common cancers in the world both in terms of incidence and mortality, more so important in low- and middle-income countries. Surgery and radiotherapy remain the backbone of treatment for non-metastatic cervical cancer, with significant improvement in survival provided by addition of chemotherapy to radiotherapy. Survival as well as quality of life is improved by chemotherapy in metastatic disease. Platinum-based chemotherapy with/without bevacizumab is the mainstay of treatment for metastatic disease and has shown improvement in survival. The right combinations and sequence of treatment modalities and medicines are still evolving. Data regarding the molecular and genomic biology of cervical cancer have revealed multiple potential targets for treatment, and several new agents are presently under evaluation including targeted therapies, immunotherapies and vaccines. This review discusses briefly the current standards, newer updates as well as future prospective approaches in systemic therapies for cervical cancer.
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Affiliation(s)
- Paul Gopu
- Department of Radiation Oncology, Amala Institute of Medical Sciences, Thrissur, Kerala, India
| | - Febin Antony
- Department of Radiation Oncology, Amala Institute of Medical Sciences, Thrissur, Kerala, India
| | - Sunu Cyriac
- Department of Medical Oncology & Haematology, Amala Institute of Medical Sciences, Thrissur, Kerala, India
| | - Katherine Karakasis
- Department of Division of Medical Oncology & Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Amit M. Oza
- Department of Division of Medical Oncology & Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
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Ishikawa M, Shibata T, Iwata T, Nishio S, Takada T, Suzuki S, Horie K, Kudaka W, Kagabu M, Tanikawa M, Kitagawa R, Takekuma M, Kobayashi H, Yaegashi N. A randomized phase II/III trial of conventional paclitaxel and carboplatin with or without bevacizumab versus dose-dense paclitaxel and carboplatin with or without bevacizumab, in stage IVB, recurrent, or persistent cervical carcinoma (JCOG1311): Primary analysis. Gynecol Oncol 2021; 162:292-298. [PMID: 34016453 DOI: 10.1016/j.ygyno.2021.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 05/07/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To assess the efficacy and safety of dose-dense weekly paclitaxel plus carboplatin (ddTC) with or without bevacizumab compared to conventional, tri-weekly paclitaxel plus carboplatin (cTC) with or without bevacizumab, in metastatic or recurrent cervical carcinoma not amenable to curative local therapy. METHODS Patients were randomly assigned to either the cTC or ddTC arm. The cTC regimen was paclitaxel 175 mg/m2 and carboplatin at an area under the curve (AUC) of 5 on day 1. The ddTC regimen was paclitaxel 80 mg/m2 on day 1, 8, 15 and carboplatin at AUC of 5 on day 1. Both cTC and ddTC treatments were repeated every 3 weeks for up to 9 cycles. After bevacizumab was approved in Japan, patients in both arms received bevacizumab 15 mg/kg if not contraindicated. The primary endpoint of phase II part was response rate (RR). If the RR of ddTC+bevacizumab was found to be at least 5% better than to cTC + bevacizumab, the study would proceed to phase III part, which had overall survival as its primary endpoint. CLINICAL TRIAL INFORMATION jRCTs031180007. RESULTS In total, 122 patients were randomly assigned to either the cTC arm (cTC + bevacizumab: 32; cTC:29) or the ddTC arm (ddTC+bevacizumab: 30; ddTC:31). The RR for patients on cTC + bevacizumab was 67.9%, and for patients on ddTC+bevacizumab 60.7%, cTC: 55.2%, and ddTC: 50.0%. CONCLUSIONS The study did not meet the primary endpoint of phase II portion. Dose-dense, weekly paclitaxel plus carboplatin is not promising for metastatic or recurrent cervical carcinoma.
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Affiliation(s)
- Mitsuya Ishikawa
- Department of Gynecology, National Cancer Center Hospital, Tokyo, Japan.
| | - Taro Shibata
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Takashi Iwata
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Shin Nishio
- Department of Obstetrics and Gynecology, Kurume University School of Medicine, Fukuoka, Japan
| | - Toshio Takada
- Department of Obstetrics and Gynecology, Kitasato University School of Medicine, Kanagawa, Japan
| | - Shiro Suzuki
- Department of Gynecologic Oncology, Aichi Cancer Center Hospital, Aichi, Japan
| | - Koji Horie
- Department of Gynecology, Saitama Cancer Center, Saitama, Japan
| | - Wataru Kudaka
- Department of Obstetrics and Gynecology, Graduate School of Medical Science, University of the Ryukyus, Okinawa, Japan
| | - Masahiro Kagabu
- Department of Obstetrics and Gynecology, Iwate Medical University school of Medicine, Iwate, Japan
| | - Michihiro Tanikawa
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Ryo Kitagawa
- Department of Gynecology and Obstetrics, Moriya Daiichi General Hospital, Ibaraki, Japan
| | | | - Hiroaki Kobayashi
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kagoshima University, Kagoshima, Japan
| | - Nobuo Yaegashi
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Miyagi, Japan
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Maene C, Salihi RR, Van Nieuwenhuysen E, Han SN, Concin N, Vergote I. Combination of weekly paclitaxel-carboplatin plus standard bevacizumab as neoadjuvant treatment in stage IB-IIB cervical cancer. Int J Gynecol Cancer 2021; 31:824-828. [PMID: 33858952 DOI: 10.1136/ijgc-2021-002432] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/26/2021] [Accepted: 03/31/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE In this study we investigated response rates of bevacizumab in addition to weekly paclitaxel and carboplatin in neoadjuvant setting in cervical cancer stage IB-IIB. METHODS In this retrospective study we included patients with FIGO 2018 stage IB-IIB cervical cancer. Treatment consisted of 9 weeks' neoadjuvant paclitaxel and carboplatin (paclitaxel 60 mg/m2, carboplatin AUC 2.7; both weekly) and bevacizumab (15 mg/kg every 3 weeks). The radiologic response rate was analyzed using the Response Evaluation Criteria in Solid Tumors (RECIST) v1.1 criteria. The definition of optimal pathological response was complete disappearance of tumor (complete response, pCR) or residual disease with less than 3 mm stromal invasion (pPR1). Suboptimal pathologic response (pPR2) was defined as persistent residual disease with more than 3 mm stromal invasion. RESULTS A total of 30 patients were included. Six patients had FIGO 2018 stage IB1-IB2 (20%), one had stage IB3 (3%), five had stage IIA (17%), and 18 had stage IIB (60%). After completing the neoadjuvant chemotherapy, all patients showed a RECIST response (seven (23%) complete response; 23 (77%) partial response). Six patients (20%) were judged to be still inoperable. After radical hysterectomy, optimal pathological response was observed in 11 patients (38%) (pCR in nine patients (29%) and pPR1 in two patients (8%)). Six patients (20%) received postoperative adjuvant chemoradiotherapy. Hematological toxicity was similar to neoadjuvant weekly paclitaxel and carboplatin, as we reported earlier. Grade IV proteinuria or hypertension was not observed and no administration of bevacizumab was delayed or dose-reduced. CONCLUSION Bevacizumab in addition to weekly paclitaxel and carboplatin showed a 100% radiological RECIST response and an optimal pathological response of 38%. Although bevacizumab has an established role in the treatment of recurrent cervical cancer in combination with paclitaxel and carboplatin, we did not observe a tendency toward superior effect on the pathological response rate of bevacizumab in the neoadjuvant chemotherapy setting.
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Affiliation(s)
- Charlotte Maene
- University Hospital Leuven, Department of Gynaecology and Obstetrics, Division of Gynaecological Oncology, Katholieke Universiteit Leuven, Leuven, Flanders, Belgium
| | - Rawand Rokan Salihi
- University Hospital Leuven, Department of Gynaecology and Obstetrics, Division of Gynaecological Oncology, Katholieke Universiteit Leuven, Leuven, Flanders, Belgium
| | - Els Van Nieuwenhuysen
- University Hospital Leuven, Department of Gynaecology and Obstetrics, Division of Gynaecological Oncology, Katholieke Universiteit Leuven, Leuven, Flanders, Belgium
| | - Sileny N Han
- University Hospital Leuven, Department of Gynaecology and Obstetrics, Division of Gynaecological Oncology, Katholieke Universiteit Leuven, Leuven, Flanders, Belgium
| | - Nicole Concin
- Department of Gynaecology and Obstetrics, Innsbruck Medical Univeristy, Innsbruck, Austria
| | - Ignace Vergote
- University Hospital Leuven, Department of Gynaecology and Obstetrics, Division of Gynaecological Oncology, Katholieke Universiteit Leuven, Leuven, Flanders, Belgium
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Tanshinone II A enhances pyroptosis and represses cell proliferation of HeLa cells by regulating miR-145/GSDMD signaling pathway. Biosci Rep 2021; 40:222522. [PMID: 32232409 PMCID: PMC7160242 DOI: 10.1042/bsr20200259] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 03/20/2020] [Accepted: 03/30/2020] [Indexed: 12/19/2022] Open
Abstract
Cervical cancer is the fourth most common cancer in women globally. Lack of effective pharmacotherapies for cervical cancer mainly attributed to an elusive understanding of the mechanism underlying its pathogenesis. Pyroptosis plays a key role in inflammation and cancer. Our study identified microRNA (miR) 145 (miR-145)/gasdermin D (GSDMD) signaling pathway as critical mediators in the effect of tanshinone II A on HeLa cells. In the present study, we found that treatment of tanshinone II A led to an obvious repression of cell proliferation and an increase in apoptosis on HeLa cells, especially in high concentration. Compared with the controlled group, tanshinone II A enhanced the activity of caspase3 and caspase9. Notably, the results demonstrated that tanshinone II A regulated cell proliferation of HeLa cells by regulating miR-145/GSDMD signaling pathway. Treatment of tanshinone II A significantly up-regulated the expression of GSDMD and miR-145. After transfection of si-miR-145 plasmids, the effects of tanshinone II A on HeLa cells were converted, including cell proliferation, apoptosis and pyroptosis. In addition, the results showed that tanshinone II A treatment altered the expression level of PI3K, p-Akt, NF-kB p65 and Lc3-I. Collectively, our findings demonstrate that tanshinone II A exerts anticancer activity on HeLa cells by regulating miR-145/GSDMD signaling. The present study is the first time to identify miR-145 as a candidate target in cervical cancer and show an association between miR-145 and pyroptosis, which provides a novel therapy for the treatment of cervical cancer.
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The Role of microRNAs in the Cisplatin- and Radio-Resistance of Cervical Cancer. Cancers (Basel) 2021; 13:cancers13051168. [PMID: 33803151 PMCID: PMC7963155 DOI: 10.3390/cancers13051168] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/26/2021] [Accepted: 03/03/2021] [Indexed: 12/30/2022] Open
Abstract
Cervical cancer is the fourth leading cause of cancer-related death among women worldwide. The chemotherapeutical agent cisplatin, a small platinum-based compound, is considered as the standard therapy for locally advanced cervical cancer or recurrent cancers, sometimes in combination with radiotherapy or other drugs. However, drug resistance and radio-resistance phenomena could reduce the life expectancy of cervical cancer patients. Resistance mechanisms are complex and often involve multiple cellular pathways in which microRNAs (miRNAs) play a fundamental role. miRNAs are a class of endogenous non-coding small RNAs responsible for post-transcriptional gene regulation. Convincing evidence demonstrates that several deregulated miRNAs are important regulators in the onset of drug and radioresistance in cervical cancer, thus underlying their potential applications in a clinical setting. In this review, we summarized the mechanisms by which miRNAs affect both cisplatin and radioresistance in cervical cancer. We also described the regulatory loops between miRNAs and lncRNAs promoting drug resistance. Besides, we reported evidence for the role of miRNAs in sensitizing cancer cells to cisplatin-based chemotherapy, and provided some suggestions for the development of new combined therapies for cervical cancer.
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Randall LM, Mayadev J, Monk BJ. Sequential Chemotherapy for Early-Stage, Post-Radical Hysterectomy Cervical Cancer: Are the STARS Aligned? JAMA Oncol 2021; 7:353-354. [PMID: 33443572 DOI: 10.1001/jamaoncol.2020.7184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Leslie M Randall
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Virginia Commonwealth University Health/Massey Cancer Center, Richmond, Virginia
| | - Jyoti Mayadev
- Department of Radiation Medicine and Applied Sciences, University of California Medical Center, San Diego, La Jolla, California
| | - Bradley J Monk
- Arizona Oncology (US Oncology Network), University of Arizona College of Medicine, Phoenix.,Creighton University School of Medicine, Phoenix, Arizona
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21
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A Comparative Study of Two Protocols of Concurrent Chemotherapy with External Beam Radiotherapy in Treatment of Locally Advanced Cervical Cancer: Cisplatin Versus Cisplatin Plus Capecitabine Combination. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2021. [DOI: 10.1007/s40944-021-00501-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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22
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Zhu J, Lou R, Ji S, Wu G, Chen Q, Hu Q, Zhao Y, Cai D, Gu K. Weekly versus triweekly cisplatin-alone adjuvant chemoradiotherapy after radical hysterectomy for stages IB-IIA cervical cancer with risk of recurrence. Anticancer Drugs 2020; 32:203-209. [PMID: 33186140 DOI: 10.1097/cad.0000000000001018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Weekly and triweekly cisplatin-alone concomitant chemoradiotherapy regimens after radical surgery were compared in stages IB-IIA cervical cancer with intermediate- or high-risk factors to identify the better therapeutic regimen. We retrospectively analyzed patients with stages IB-IIA cervical cancer who received radical hysterectomy followed by concurrent adjuvant chemoradiotherapy to compare the efficiency between weekly and triweekly regimen groups. We evaluated between-group differences in survival, recurrence, compliance, and adverse effects. A total of 217 patients were included in this study (triweekly group vs. weekly group; 97 vs. 120). The mean follow-up was 47.2 months. The 5-year disease-free survival (DFS) was 84.4% or 76.5% for patients treated with triweekly cisplatin chemotherapy or the weekly regimen, respectively (P = 0.110). The 5-year overall survival (OS) was 82.4 and 78.6% for the same treatment groups, respectively (P = 0.540). The DFS of the patients with pelvic lymph node metastasis were marginally better in triweekly regimen group compared with the weekly group (P = 0.031). Grades 3-4 leukopenia was significantly more common in the triweekly group (P = 0.028). The weekly cisplatin chemotherapy group experienced the same therapeutic effect as the triweekly cisplatin-alone chemotherapy group but with less toxicity. However, triweekly cisplatin regimen reduced the recurrence in patients with pelvic lymph node metastasis.
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Affiliation(s)
- Jiahao Zhu
- Department of Radiotherapy and Oncology, Affiliated Hospital of Jiangnan University, Wuxi
| | - Rui Lou
- Department of Radiotherapy and Oncology, Affiliated Hospital of Jiangnan University, Wuxi
| | - Shengjun Ji
- Department of Radiotherapy and Oncology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu
| | - Gang Wu
- Department of Radiotherapy and Oncology, Affiliated Hospital of Jiangnan University, Wuxi
| | - Qingqing Chen
- Department of Radiotherapy and Oncology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu
| | - Qunchao Hu
- Department of Radiation Oncology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, P.R. China
| | - Yutian Zhao
- Department of Radiotherapy and Oncology, Affiliated Hospital of Jiangnan University, Wuxi
| | - Dongyan Cai
- Department of Radiotherapy and Oncology, Affiliated Hospital of Jiangnan University, Wuxi
| | - Ke Gu
- Department of Radiotherapy and Oncology, Affiliated Hospital of Jiangnan University, Wuxi
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Gadducci A, Cosio S. Pharmacological Treatment of Patients with Metastatic, Recurrent or Persistent Cervical Cancer Not Amenable by Surgery or Radiotherapy: State of Art and Perspectives of Clinical Research. Cancers (Basel) 2020; 12:E2678. [PMID: 32961781 PMCID: PMC7565040 DOI: 10.3390/cancers12092678] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 09/04/2020] [Accepted: 09/16/2020] [Indexed: 02/07/2023] Open
Abstract
Cervical cancer patients with distant or loco-regional recurrences not amenable by surgery or radiotherapy have limited treatment options, and their 5-year overall survival (OS) rates range from 5% to 16%. The purpose of this paper is to assess the results obtained with chemotherapy and biological agents in this clinical setting. Several phase II trials of different cisplatin (CDDP)-based doublets and a phase III randomized trial showing a trend in response rate, progression-free survival, and OS in favor of CDDP + paclitaxel (PTX) compared with other CDDP-based doublets have been reviewed. The factors predictive of response to chemotherapy as well as the benefits and risks of the addition of bevacizumab to CDDP + PTX have been analyzed. The FDA has recently approved pembrolizumab for patients with recurrent or metastatic cervical cancer in progression on or after chemotherapy whose tumors were PD-L1 positive. Interesting perspectives of clinical research are represented by the use of immune checkpoint inhibitors alone or in addition to chemotherapy, whereas PARP inhibitors and PI3K inhibitors are still at the basic research phase, but promising.
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Affiliation(s)
- Angiolo Gadducci
- Department of Clinical and Experimental Medicine, Division of Gynecology and Obstetrics, University of Pisa, 56127 Pisa, Italy;
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24
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Çakır C, Yüksel D, Kılıç Ç, Ünsal M, Dur R, Boyraz G, Karalok A, Moraloğlu Tekin Ö, Turan T. Bone recurrence after radical hysterectomy and lymphadenectomy in early-stage cervical cancer. Turk J Obstet Gynecol 2020; 16:266-270. [PMID: 32231859 PMCID: PMC7090266 DOI: 10.4274/tjod.galenos.2019.26932] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 10/12/2019] [Indexed: 12/01/2022] Open
Abstract
Objective: To present the clinical, surgical, and pathologic features of bone recurrence in patients who underwent radical hysterectomy for early-stage uterine cervical cancer. Materials and Methods: Data of 412 patients who underwent type III radical hysterectomy and pelvic ± paraaortic lymphadenectomy for stage 1B-2A epithelial cervical cancer were reviewed. Seven (1.7%) patients with bone recurrence in the first recurrence were included in the study. Results: The median follow-up of the main cohort (n=412) was 46 (range=1-300) months. In this period, recurrence developed in 53 (12.9%) patients and recurrence was observed in bone in 13.2% (7 of 53) of these recurrences. Time to recurrence ranged from 9 to 45 months. Of the recurrences, five were in the axial skeleton and two were in the appendicular skeleton. Recurrence was observed in lumbar vertebrae in three patients, thoracic vertebrae in one patient, sacral vertebrae in one patient, lumbosacral vertebrae in one patient, and the left femur in two patients. Four patients had multiple recurrence in 3 patients despite isolated bone recurrence. Patients with multiple recurrences died within 6-25 months. All isolated bone recurrences were in the axial skeleton. Complete clinical response with salvage therapy was achieved in two patients with isolated bone recurrence. Conclusion: Complete clinical response and long postoperative survival can be achieved with salvage treatment when bone recurrence is solitary in cervical cancers.
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Affiliation(s)
- Caner Çakır
- Etlik Zübeyde Hanım Women's Health Training and Research Hospital, Clinic of Gynecologic Oncology, Ankara, Turkey
| | - Dilek Yüksel
- Etlik Zübeyde Hanım Women's Health Training and Research Hospital, Clinic of Gynecologic Oncology, Ankara, Turkey
| | - Çiğdem Kılıç
- Etlik Zübeyde Hanım Women's Health Training and Research Hospital, Clinic of Gynecologic Oncology, Ankara, Turkey
| | - Mehmet Ünsal
- Etlik Zübeyde Hanım Women's Health Training and Research Hospital, Clinic of Gynecologic Oncology, Ankara, Turkey
| | - Rıza Dur
- Etlik Zübeyde Hanım Women's Health Training and Research Hospital, Clinic of Gynecologic Oncology, Ankara, Turkey
| | - Gökhan Boyraz
- Etlik Zübeyde Hanım Women's Health Training and Research Hospital, Clinic of Gynecologic Oncology, Ankara, Turkey
| | - Alper Karalok
- Etlik Zübeyde Hanım Women's Health Training and Research Hospital, Clinic of Gynecologic Oncology, Ankara, Turkey
| | - Özlem Moraloğlu Tekin
- Etlik Zübeyde Hanım Women's Health Training and Research Hospital, Clinic of Gynecologic Oncology, Ankara, Turkey
| | - Taner Turan
- Etlik Zübeyde Hanım Women's Health Training and Research Hospital, Clinic of Gynecologic Oncology, Ankara, Turkey
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25
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Della Corte L, Barra F, Foreste V, Giampaolino P, Evangelisti G, Ferrero S, Bifulco G. Advances in paclitaxel combinations for treating cervical cancer. Expert Opin Pharmacother 2020; 21:663-677. [DOI: 10.1080/14656566.2020.1724284] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Luigi Della Corte
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples “Federico II”, Naples, Italy
| | - Fabio Barra
- Academic Unit of Obstetrics and Gynecology, IRCCS AOU San Martino – IST, Genoa, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (Dinogmi), University of Genoa, Genoa, Italy
| | - Virginia Foreste
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples “Federico II”, Naples, Italy
| | - Pierluigi Giampaolino
- Department of Public Health, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Giulio Evangelisti
- Academic Unit of Obstetrics and Gynecology, IRCCS AOU San Martino – IST, Genoa, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (Dinogmi), University of Genoa, Genoa, Italy
| | - Simone Ferrero
- Academic Unit of Obstetrics and Gynecology, IRCCS AOU San Martino – IST, Genoa, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (Dinogmi), University of Genoa, Genoa, Italy
| | - Giuseppe Bifulco
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples “Federico II”, Naples, Italy
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Tewari KS, Monk BJ. Evidence-Based Treatment Paradigms for Management of Invasive Cervical Carcinoma. J Clin Oncol 2019; 37:2472-2489. [PMID: 31403858 PMCID: PMC7098831 DOI: 10.1200/jco.18.02303] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2019] [Indexed: 12/24/2022] Open
Affiliation(s)
| | - Bradley J. Monk
- University of Arizona, Phoenix, AZ
- Creighton University, Phoenix, AZ
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Kaempferia parviflora Extract Inhibits STAT3 Activation and Interleukin-6 Production in HeLa Cervical Cancer Cells. Int J Mol Sci 2019; 20:ijms20174226. [PMID: 31470515 PMCID: PMC6747281 DOI: 10.3390/ijms20174226] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 08/23/2019] [Accepted: 08/27/2019] [Indexed: 02/06/2023] Open
Abstract
Kaempferia parviflora (KP) has been reported to have anti-cancer activities. We previously reported its effects against cervical cancer cells and continued to elucidate the effects of KP on inhibiting the production and secretion of interleukin (IL)-6, as well as its relevant signaling pathways involved in cervical tumorigenesis. We discovered that KP suppressed epidermal growth factor (EGF)-induced IL-6 secretion in HeLa cells, and it was associated with a reduced level of Glycoprotein 130 (GP130), phosphorylated signal transducers and activators of transcription 3 (STAT3), and Mcl-1. Our data clearly showed that KP has no effect on nuclear factor kappa B (NF-κB) localization status. However, we found that KP inhibited EGF-stimulated phosphorylation of tyrosine 1045 and tyrosine 1068 of EGF receptor (EGFR) without affecting its expression level. The inhibition of EGFR activation was verified by the observation that KP significantly suppressed a major downstream MAP kinase, ERK1/2. Consistently, KP reduced the expression of Ki-67 protein, which is a cellular marker for proliferation. Moreover, KP potently inhibited phosphorylation of STAT3, Akt, and the expression of Mcl-1 in response to exogenous IL-6 stimulation. These data suggest that KP suppresses EGF-induced production of IL-6 and inhibits its autocrine IL-6/STAT3 signaling critical for maintaining cancer cell progression. We believe that KP may be a potential alternative anti-cancer agent for suppressing cervical tumorigenesis.
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Duenas-Gonzalez A, Gonzalez-Fierro A. Pharmacodynamics of current and emerging treatments for cervical cancer. Expert Opin Drug Metab Toxicol 2019; 15:671-682. [DOI: 10.1080/17425255.2019.1648431] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Alfonso Duenas-Gonzalez
- Unit of Biomedical Research on Cancer, Instituto de Investigaciones Biomédicas UNAM/Instituto Nacional de Cancerología, Mexico City, Mexico
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29
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Liontos M, Kyriazoglou A, Dimitriadis I, Dimopoulos MA, Bamias A. Systemic therapy in cervical cancer: 30 years in review. Crit Rev Oncol Hematol 2019; 137:9-17. [DOI: 10.1016/j.critrevonc.2019.02.009] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Revised: 12/09/2018] [Accepted: 02/24/2019] [Indexed: 11/25/2022] Open
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Tewari KS. Immune Checkpoint Blockade in PD-L1-Positive Platinum-Refractory Cervical Carcinoma. J Clin Oncol 2019; 37:1449-1454. [PMID: 31026210 DOI: 10.1200/jco.19.00119] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
The Oncology Grand Rounds series is designed to place original reports published in the Journal into clinical context. A case presentation is followed by a description of diagnostic and management challenges, a review of the relevant literature, and a summary of the authors' suggested management approaches. The goal of this series is to help readers better understand how to apply the results of key studies, including those published in Journal of Clinical Oncology, to patients seen in their own clinical practice. A 36-year-old white married mother of two small children presented with intermenstrual bleeding, dyspareunia, and pelvic pain. Because of significant lapses in health care coverage, she had had only sporadic screening for cervical cancer over the past 15 years. On evaluation with a vaginal speculum, her cervix was found to have been replaced by a friable lesion 5 cm in diameter. Biopsy revealed poorly differentiated, squamous cell carcinoma. Bimanual pelvic and rectovaginal examination, as well as radiographic imaging studies, were consistent with an International Federation of Gynecology and Obstetrics (FIGO) stage IB3 squamous cell carcinoma of the cervix. She was treated with cisplatin-based chemoradiation (40 mg/m2 body surface area once per week with a planned total dose of 50 Gy using intensity modulated radiotherapy) plus high-dose-rate intracavitary brachytherapy (to bring the total dose to point A to 80 to 85 Gy). Despite missing eight radiotherapy sessions because of transportation issues, she had a complete clinical response. Fourteen months later, she developed severe pelvic and right flank pain. In the clinic, she was cachectic and reported significant abdominal discomfort that kept her from eating well over the past several months. She was no longer able to work as a medical assistant and spent most of her time confined to her apartment. Physical examination demonstrated a fixed, firm pelvic mass; a computed tomography-guided biopsy confirmed recurrent carcinoma, and staging scans disclosed a pulmonary metastasis.
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A Randomized Phase 2 Study of ADXS11-001 Listeria monocytogenes-Listeriolysin O Immunotherapy With or Without Cisplatin in Treatment of Advanced Cervical Cancer. Int J Gynecol Cancer 2019. [PMID: 29538258 PMCID: PMC5929492 DOI: 10.1097/igc.0000000000001235] [Citation(s) in RCA: 97] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Supplemental digital content is available in the text. Objectives A global unmet medical need exists for effective treatments for persistent, recurrent, or metastatic cervical cancer, as patients have a short life expectancy. Recently, immunotherapies have shown promising survival benefits for patients with advanced forms of cancer. Axalimogene filolisbac (ADXS11-001), a Listeria monocytogenes immunotherapy with a broad effect on the immune system, is under investigation for treatment of human papillomavirus–associated cancers including cervical cancer. Methods This phase 2 study evaluated the safety and efficacy of ADXS11-001, administered with or without cisplatin, in patients with recurrent/refractory cervical cancer following prior chemotherapy and/or radiotherapy. A total of 109 patients were treated, and 69 were evaluable for tumor response at equal to or more than 3 months postbaseline. Results Median overall survival (OS) was comparable between treatment groups (ADXS11-001: 8.28 months; 95% confidence interval [CI], 5.85–10.5 months; ADXS11-001 + cisplatin: 8.78 months; 95% CI, 7.4–13.3 months). The 12- and 18-month milestone OS rates were 30.9% versus 38.9%, and 23.6% versus 25.9% for each group, respectively (34.9% and 24.8% combined). Median progression-free survival (6.10 vs 6.08 months) and the overall response rate (17.1% vs 14.7%) were similar for both groups. ADXS11-001 was generally well tolerated; adverse events were predominantly mild to moderate in severity and not related to treatment. More adverse events were reported in the combination group (429 vs 275). Conclusions These promising safety and efficacy results, including the encouraging 12-month 34.9% combined OS rate, warrant further investigation of ADXS11-001 for treatment of recurrent/refractory cervical cancer.
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Chung HC, Ros W, Delord JP, Perets R, Italiano A, Shapira-Frommer R, Manzuk L, Piha-Paul SA, Xu L, Zeigenfuss S, Pruitt SK, Leary A. Efficacy and Safety of Pembrolizumab in Previously Treated Advanced Cervical Cancer: Results From the Phase II KEYNOTE-158 Study. J Clin Oncol 2019; 37:1470-1478. [PMID: 30943124 DOI: 10.1200/jco.18.01265] [Citation(s) in RCA: 602] [Impact Index Per Article: 120.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
PURPOSE KEYNOTE-158 ( ClinicalTrials.gov identifier: NCT02628067) is a phase II basket study investigating the antitumor activity and safety of pembrolizumab in multiple cancer types. We present interim results from patients with previously treated advanced cervical cancer. PATIENTS AND METHODS Patients received pembrolizumab 200 mg every 3 weeks for 2 years or until progression, intolerable toxicity, or physician or patient decision. Tumor imaging was performed every 9 weeks for the first 12 months and every 12 weeks thereafter. The primary end point was objective response rate (ORR), assessed per Response Evaluation Criteria in Solid Tumors (version 1.1) by independent central radiologic review. Safety was a secondary end point. RESULTS Ninety-eight patients were treated. Median age was 46.0 years (range, 24 to 75 years), and 65.3% of patients had Eastern Cooperative Oncology Group performance status of 1. Eighty-two patients (83.7%) had programmed death-ligand 1 (PD-L1)-positive tumors (combined positive score ≥ 1), 77 having previously received one or more lines of chemotherapy for recurrent or metastatic disease. Median follow-up was 10.2 months (range, 0.6 to 22.7 months). ORR was 12.2% (95% CI, 6.5% to 20.4%), with three complete and nine partial responses. All 12 responses were in patients with PD-L1-positive tumors, for an ORR of 14.6% (95% CI, 7.8% to 24.2%); 14.3% (95% CI, 7.4% to 24.1%) of these responses were in those who had received one or more lines of chemotherapy for recurrent or metastatic disease. Median duration of response was not reached (range, ≥ 3.7 to ≥ 18.6 months). Treatment-related adverse events occurred in 65.3% of patients, and the most common were hypothyroidism (10.2%), decreased appetite (9.2%), and fatigue (9.2%). Treatment-related grade 3 to 4 adverse events occurred in 12.2% of patients. CONCLUSION Pembrolizumab monotherapy demonstrated durable antitumor activity and manageable safety in patients with advanced cervical cancer. On the basis of these results, the US Food and Drug Administration granted accelerated approval of pembrolizumab for patients with advanced PD-L1-positive cervical cancer who experienced progression during or after chemotherapy.
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Affiliation(s)
- Hyun Cheol Chung
- 1 Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Willeke Ros
- 2 Antoni van Leeuwenhoek Ziekenhuis, Amsterdam, the Netherlands
| | - Jean-Pierre Delord
- 3 Institut Claudius Regaud and Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse, France
| | - Ruth Perets
- 4 Rambam Health Care Campus, Technion - Israel Institute of Technology, Haifa, Israel
| | | | | | - Lyudmila Manzuk
- 7 NN Blokhin National Medical Research Center of Oncology, Moscow, Russia
| | | | - Lei Xu
- 9 Merck & Co, Kenilworth, NJ
| | | | | | - Alexandra Leary
- 10 Gustave Roussy Cancer Campus and University of Paris-Saclay, Villejuif, France
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Marshall C, Rajdev MA, Somarouthu B, Ramaiya NH, Alessandrino F. Overview of systemic treatment in recurrent and advanced cervical cancer: a primer for radiologists. Abdom Radiol (NY) 2019; 44:1506-1519. [PMID: 30288585 DOI: 10.1007/s00261-018-1797-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Imaging has a central role in surveillance of cervical cancer, guiding decision on when to initiate treatment for recurrent disease and to guide management in advanced cervical cancer. Due to the increased availability of pelvic radiation therapy, the rate of atypical presentation of recurrent disease has increased. Simultaneously, the array of systemic therapies now available for advanced cervical cancer has considerably expanded in the last few years, with therapies now available in mid and low-income countries. While pelvic recurrences are amenable of loco-regional treatment, recurrent disease may present with metastases to the thoracoabdominal organs, lymph nodes, bones, skin and brain, for which systemic treatment represent the standard of care. Besides combined chemotherapy regimens, alternative chemotherapies, biosimilars and immune checkpoint inhibitors are now available, each associated with a definite pattern of response and toxicity. In this review, after describing the typical and atypical presentations of recurrent and advanced cervical carcinoma on cross-sectional imaging, we will discuss systemic treatment for recurrent or advanced disease and their associated radiographic sequelae, in light of the newly available therapies.
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Loizzi V, Del Vecchio V, Crupano FM, Minicucci V, Fumarulo VV, Resta L, Vimercati A, Bettocchi S, Cicinelli E, Cormio G. A phase II study: dose-dense carboplatin and paclitaxel as neoadjuvant chemotherapy in locally advanced cervical cancer. J Chemother 2019; 30:247-252. [PMID: 30375951 DOI: 10.1080/1120009x.2018.1489601] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
This study evaluates the efficacy and toxicity of dose-dense weekly paclitaxel and carboplatin as neoadjuvant chemotherapy in locally advanced cervical cancer (LACC). We collected 23 cases of LACC treated with weekly paclitaxel and carboplatin for nine cycles: 20 patients had complete or partial response to chemotherapy and were submitted to surgery, 3 with poor response received chemoradiation therapy. Pathologic examination showed complete response in four patients, myometrial invasion <50% in nine and >50% in seven patients, parametrial involvement in two, vaginal metastasis in one and lymphovascular space invasion, with positive margins, in another case. Despite seven patients had radiological evidence of lymph nodes involvement at diagnosis, only one had nodal metastases. Five patients showed grade 3-4 of hematologic toxicity.
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Affiliation(s)
- Vera Loizzi
- a Gynecologic Oncology Unit, Department of Biomedical Science and Human Oncology , University of Bari , Bari , Italy
| | - Vittoria Del Vecchio
- a Gynecologic Oncology Unit, Department of Biomedical Science and Human Oncology , University of Bari , Bari , Italy
| | - Francesco M Crupano
- a Gynecologic Oncology Unit, Department of Biomedical Science and Human Oncology , University of Bari , Bari , Italy
| | - Valentina Minicucci
- a Gynecologic Oncology Unit, Department of Biomedical Science and Human Oncology , University of Bari , Bari , Italy
| | - Valeria V Fumarulo
- a Gynecologic Oncology Unit, Department of Biomedical Science and Human Oncology , University of Bari , Bari , Italy
| | - Leonardo Resta
- b Department of Pathology , University of Bari , Bari , Italy
| | - Antonella Vimercati
- a Gynecologic Oncology Unit, Department of Biomedical Science and Human Oncology , University of Bari , Bari , Italy
| | - Stefano Bettocchi
- a Gynecologic Oncology Unit, Department of Biomedical Science and Human Oncology , University of Bari , Bari , Italy
| | - Ettore Cicinelli
- a Gynecologic Oncology Unit, Department of Biomedical Science and Human Oncology , University of Bari , Bari , Italy
| | - Gennaro Cormio
- a Gynecologic Oncology Unit, Department of Biomedical Science and Human Oncology , University of Bari , Bari , Italy.,c Gynecologic Oncology Unit, Department of Biomedical Science and Human Oncology , University of Bari, National Cancer Institute Bari , Bari , Italy
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Management of Recurrent or Residual Cervical Cancer with Cisplatin and Topotecan Combination Therapy in a Palliative Setting: A Prospective Study. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2018. [DOI: 10.1007/s40944-018-0239-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Zhou JG, Zhou NJ, Zhang Q, Feng YY, Zhou H. Apatinib for patients with advanced or recurrent cervical cancer: study protocol for an open-label randomized controlled trial. Trials 2018; 19:500. [PMID: 30223869 PMCID: PMC6142681 DOI: 10.1186/s13063-018-2858-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Accepted: 08/12/2018] [Indexed: 12/28/2022] Open
Abstract
Background In China, cervical cancer is the fifth most commonly diagnosed cancer, and the outcomes for patients with advanced or recurrent disease are poor. Apatinib, a small molecule inhibitor of vascular endothelial growth factor receptor (VEGFR-2), is an orally bioavailable agent, which has shown survival benefit in multiple solid tumors. Based on previous research, this phase II clinical trial aims to verify apatinib’s efficacy and safety in patients with advanced or recurrent cervical cancer. Methods/design This randomized, parallel arm, open-label, interventional trial will be carried out to evaluate the efficacy and the safety of apatinib for advanced or recurrent cervical cancer. A total of 60 eligible patients will be allocated by intention, in a ratio of 1:1, to either the experimental group or the control group. The primary endpoint is progression-free survival, the secondary endpoints include overall survival, disease control rate, objective response rate, quality of life, and adverse events. Assessments will be carried out before enrolment (baseline) and every 4 weeks after treatment. Discussion The aim of this trial is to demonstrate the clinical effect, safety, and side effects of apatinib in the treatment of advanced or recurrent cervical cancer. This study will clarify the efficacy and safety of this regimen. Trial registration Chinese Clinical Trials Registry, ChiCTR-OIN-17012164. Registered on 24 July 2017. Electronic supplementary material The online version of this article (10.1186/s13063-018-2858-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jian-Guo Zhou
- Department of Oncology, Affiliated Hospital of Zunyi Medical University, NO.149, Dalian Road, Zunyi, 563000, China.
| | - Nan-Jing Zhou
- Department of Oncology, Affiliated Hospital of Zunyi Medical University, NO.149, Dalian Road, Zunyi, 563000, China
| | - Qiong Zhang
- Department of Oncology, Affiliated Hospital of Zunyi Medical University, NO.149, Dalian Road, Zunyi, 563000, China
| | - Yao-Yao Feng
- Department of Oncology, Affiliated Hospital of Zunyi Medical University, NO.149, Dalian Road, Zunyi, 563000, China
| | - Hang Zhou
- Department of Oncology, Affiliated Hospital of Zunyi Medical University, NO.149, Dalian Road, Zunyi, 563000, China.
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Leath CA, Monk BJ. Twenty-first century cervical cancer management: A historical perspective of the gynecologic oncology group/NRG oncology over the past twenty years. Gynecol Oncol 2018; 150:391-397. [PMID: 29954593 PMCID: PMC6102091 DOI: 10.1016/j.ygyno.2018.06.023] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 06/13/2018] [Accepted: 06/20/2018] [Indexed: 02/04/2023]
Abstract
Since 1970, the Gynecologic Oncology Group (GOG) has been at the forefront of evaluating and helping to implement ground breaking and paradigm changing research in the management of cervical cancer. While the most dramatic example of this impact was a series of clinical trials published in 1999 that evaluated chemoradiation therapy versus radiation therapy alone for patients with various clinical scenarios, including both locally advanced as well as post radical hysterectomy patients, investigation has continued to further refine and improve therapy. In 2014, based on the results of GOG protocol 240, bevacizumab became the first approved targeted therapy in a gynecologic cancer in the United States. Most recently, clinical trial work from the GOG is changing the standard of care for all clinical scenarios. Finally, an emphasis on survivorship and special populations are now top priorities.
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Affiliation(s)
- Charles A Leath
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of Alabama at Birmingham, Birmingham, AL, United States of America.
| | - Bradley J Monk
- Division of Gynecologic Oncology, Arizona Oncology (US Oncology Network), University of Arizona College of Medicine, Creighton University School of Medicine at St. Joseph's Hospital Phoenix, AZ, United States of America
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Aoki Y, Ochiai K, Lim S, Aoki D, Kamiura S, Lin H, Katsumata N, Cha SD, Kim JH, Kim BG, Hirashima Y, Fujiwara K, Kim YT, Kim SM, Chung HH, Chang TC, Kamura T, Takizawa K, Takeuchi M, Kang SB. Phase III study of cisplatin with or without S-1 in patients with stage IVB, recurrent, or persistent cervical cancer. Br J Cancer 2018; 119:530-537. [PMID: 30072745 PMCID: PMC6162273 DOI: 10.1038/s41416-018-0206-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Revised: 06/18/2018] [Accepted: 07/10/2018] [Indexed: 12/29/2022] Open
Abstract
Background This open-label phase III trial evaluated efficacy and safety of S-1 plus cisplatin vs. cisplatin alone as first-line chemotherapy in patients with stage IVB, recurrent, or persistent cervical cancer. Methods Patients were randomised (1:1) to S-1 plus cisplatin (study group) or cisplatin alone (control group). In each cycle, cisplatin 50 mg/m2 was administered on Day 1 in both groups. S-1 was administered orally at 80–120 mg daily on Days 1–14 of a 21-day cycle in the study group. The primary endpoint was overall survival (OS). Results A total of 375 patients were enrolled, of whom 364 (188, study group; 176, control group) received treatment. Median OS was 21.9 and 19.5 months in the study and control groups, respectively (log-rank P = 0.125; hazard ratio [HR] 0.84, 95% confidence interval [CI] 0.67–1.05). Median progression-free survival (PFS) was 7.3 and 4.9 months in the study and control groups, respectively (HR 0.62, 95% CI 0.48–0.80, P < 0.001). The adverse event (AE) rate increased in the study group despite the absence of any unexpected AEs. Conclusions S-1 plus cisplatin did not show superiority over cisplatin alone in OS but significantly increased PFS in patients with stage IVB, recurrent, or persistent cervical cancer. Since the standard therapy has changed in the course of this study, further studies are warranted to confirm the clinical positioning of S-1 combined with cisplatin for this population.
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Affiliation(s)
- Yoichi Aoki
- Department of Obstetrics and Gynecology, Graduate School of Medical Science, University of the Ryukyus, 207 Uehara Nishihara-cho, Nakagami-gun, Okinawa, 903-0215, Japan
| | - Kazunori Ochiai
- Department of Obstetrics and Gynecology, The Jikei University School of Medicine, 3-19-18, Nishishimbashi, Minato-ku, Tokyo, 105-8471, Japan.
| | - Soyi Lim
- Department of Obstetrics and Gynecology, Gachon University Gil Medical Center, 1198 Guwol-dong, Namdong-gu, Incheon, 405-760, Korea
| | - Daisuke Aoki
- Department of Obstetrics and Gynecology, Keio University School of Medicine, 35 Shinanomachi, Shinjyuku-ku, Tokyo, 160-8582, Japan
| | - Shoji Kamiura
- Department of Gynecology, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-ku, Osaka, Osaka, 541-8567, Japan
| | - Hao Lin
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No. 123, Ta-Pei Road, Niao-Sung District, Kaohsiung, 83301, Taiwan
| | - Noriyuki Katsumata
- Department of Breast and Medical Oncology, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.,Department of Medical Oncology, Nippon Medical School Musashikosugi Hospital, 1-396, Kosugi-cho, Nakahara-ku, Kawasaki-shi, Kanagawa, 211-8533, Japan
| | - Soon-Do Cha
- Department of Obstetrics and Gynecology, Keimyung University School of Medicine, 194 Dong San Dong, Daegu, 700-712, Korea
| | - Jae-Hoon Kim
- Department of Obstetrics and Gynecology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea
| | - Byoung-Gie Kim
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-Dong, Gangnam-gu, Seoul, 135-710, Korea
| | - Yasuyuki Hirashima
- Department of Gynecology, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Keiichi Fujiwara
- Department of Gynecologic Oncology, Saitama Medical University International Medical Center, 1397-1, Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Young-Tak Kim
- Department of Obstetrics and Gynecology, Asan Medical Center, 388-1 Pungnap-2dong, Songpa-gu, Seoul, 138-736, Korea
| | - Seok Mo Kim
- Department of Obstetrics and Gynecology, Chonnam National University Hwasun Hospital, 160 Ilsimri Hwasun-eup, Hwasun, Jeonnam, 519-809, Korea
| | - Hyun Hoon Chung
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, 50 Ilwon-Dong, Gangnam-gu, Seoul, 135-710, Korea
| | - Ting-Chang Chang
- Department of Obstetrics and Gynecology, Linkou Chang Gung Memorial Hospital and Chang Gung University Medical College, No.5, Fu-Shin Street, Kueishan County, Taoyuan, 33305, Taiwan
| | - Toshiharu Kamura
- Department of Obstetrics and Gynecology, Kurume University School of Medicine, Asahi-machi 67, Kurume, Fukuoka, 830-0011, Japan
| | - Ken Takizawa
- Department of Gynecology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, 3-10-6, Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Masahiro Takeuchi
- Department of Clinical Medicine (Biostatistics), Kitasato University School of Pharmacy, Shirokane 5-9-1, Minato-ku, Tokyo, 108-8641, Japan
| | - Soon-Beom Kang
- Department of Obstetrics and Gynecology, Konkuk University School of Medicine, 120-1 Neungdong-ro, Gwangjin-gu, Seoul, 05080, Korea
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Zhu J, Ji S, Hu Q, Chen Q, Liu Z, Wu J, Gu K. Concurrent weekly single cisplatin vs triweekly cisplatin alone with radiotherapy for treatment of locally advanced cervical cancer: a meta-analysis. Cancer Manag Res 2018; 10:1975-1985. [PMID: 30034252 PMCID: PMC6047860 DOI: 10.2147/cmar.s167938] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background Radiotherapy (RT) concurrent with cisplatin (CDDP) is the standard regimen used for treatment of locally advanced cervical carcinoma. In this meta-analysis, we compared the weekly and triweekly single CDDP concomitant chemoradiation regimens for treatment of cervical cancer with respect to compliance, recurrence, survival, and acute adverse effects. Materials and methods A systematic search for relevant studies was conducted in PubMed, Cochrane Library, EMBASE, and Medline databases. Fixed- or random-effects model was used for pooled analysis. The end points were overall survival, recurrence, compliance, and acute adverse effect reported as odds ratios (ORs) and 95% CIs. Results Six randomized trials and two retrospective studies qualified the inclusion criteria. The regimen of triweekly CDDP alone concurrent with RT showed better compliance (OR, 0.49; 95% CI, 0.29–0.83; P=0.009). No significant difference was observed between the 2 arms with respect to recurrence, survival, and acute adverse effects (all P>0.05). However, triweekly CDDP regimen was associated with significantly lower incidence of local recurrence (OR, 1.83; 95% CI: 1.12–3.01; P=0.02), while weekly CDDP regimen was associated with a lower risk of leucopenia (OR, 0.30; 95% CI: 0.10–0.92; P=0.03). Conclusion Triweekly single platinum chemotherapy plus concurrent RT was superior to weekly CDDP regimen with respect to local recurrence and treatment compliance in patients with locally advanced cervical carcinoma.
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Affiliation(s)
- Jiahao Zhu
- Department of Radiation Oncology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China, .,Department of Oncology, Nanjing Medical University, Nanjing, China
| | - Shengjun Ji
- Department of Radiation Oncology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China,
| | - Qunchao Hu
- Department of Radiation Oncology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China,
| | - Qingqing Chen
- Department of Radiation Oncology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China,
| | - Zhengcao Liu
- Department of Radiation Oncology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China,
| | - Jinchang Wu
- Department of Radiation Oncology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China,
| | - K Gu
- Department of Radiation Oncology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China,
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Kunos CA, Ivy SP. Triapine Radiochemotherapy in Advanced Stage Cervical Cancer. Front Oncol 2018; 8:149. [PMID: 29868473 PMCID: PMC5949312 DOI: 10.3389/fonc.2018.00149] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 04/23/2018] [Indexed: 12/23/2022] Open
Abstract
Clinical ribonucleotide reductase (RNR) inhibitors have reinvigorated enthusiasm for radiochemotherapy treatment of patients with regionally advanced stage cervical cancers. About two-thirds of patients outlive their cervical cancer (1), even though up to half of their tumors retain residual microscopic disease (2). The National Cancer Institute Cancer Therapy Evaluation Program conducted two prospective trials of triapine–cisplatin–radiation to improve upon this finding by precisely targeting cervical cancer’s overactive RNR. Triapine’s potent inactivation of RNR arrests cells at the G1/S cell cycle restriction checkpoint and enhances cisplatin–radiation cytotoxicity. In this article, we provide perspective on challenges encountered in and future potential of clinical development of a triapine–cisplatin–radiation combination for patients with regionally advanced cervical cancer. New trial results and review presented here suggest that a triapine–cisplatin–radiation combination may offer molecular cell cycle target control to maximize damage in cancers and to minimize injury to normal cells. A randomized trial now accrues patients with regionally advanced stage cervical cancer to evaluate triapine’s contribution to clinical benefit after cisplatin–radiation (clinicaltrials.gov, NCT02466971).
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Affiliation(s)
- Charles A Kunos
- Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD, United States
| | - S Percy Ivy
- Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD, United States
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Colombo A, Landoni F, Maneo A, Zanetta G, Nava S, Tancini G. Neoadjuvant Chemotherapy to Radiation and Concurrent Chemoradiation for Locally Advanced Squamous Cell Carcinoma of the Cervix: A Review of the Recent Literature. TUMORI JOURNAL 2018; 84:229-37. [PMID: 9620250 DOI: 10.1177/030089169808400222] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Radiotherapy is the standard treatment for locally advanced cervical cancer; nevertheless it fails to control disease progression within the irradiation fields in more than 40% of cases, particularly in patients with bulky tumor. Distant metastases are not infrequent in more advanced cases. Chemotherapy has been integrated with radiotherapy to improve local control and treat distant subclinical metastases. Schedules of combined treatment more frequently represented by neoadjuvant chemotherapy followed by radiation (NACT) and by concomitant chemotherapy and radiation (CT-RT). A review of the recent literature is presented. The role of NACT is controversial: high response rates are reported but doubtful advantages in terms of survival or local control have been shown. In randomized trials, hydroxyurea concomitant to radiation improves local control and survival, particularly in stage IIIB and IVA. Several randomized trials of concurrent chemoradiation with 5FU, cisplatin and mitomycin C are underway, but few have been published: no significative differences are reported in term of local control or survival. Acute toxicity is higher than in radiation alone, but usually manageable. For the analysis of late morbidity a longer follow-up is required. Large randomized trials of adequate radiotherapy versus concomitant chemoradiation are necessary to refine our understanding of the benefits of this integrated treatment.
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Affiliation(s)
- A Colombo
- Divisione di Radioterapia, Istituto di Scienze Biomediche, Ospedale S. Gerardo, Monza, Italy
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Cozzaglio L, Doci R, Colella G, Zunino F, Casciarri G, Gennari L, Colla G. A Feasibility Study of High-Dose Cisplatin and 5-Fluorouracil with Glutathione Protection in the Treatment of Advanced Colorectal Cancer. TUMORI JOURNAL 2018; 76:590-4. [PMID: 2284698 DOI: 10.1177/030089169007600617] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
On the basis of previous studies supporting that glutathione (GSH) reduced cisplatin nephrotoxicity we have designed a new regimen in the treatment of advanced colorectal cancer, which included GSH as a modulator of cisplatin-induced toxicity. Eleven untreated patients with measurable metastatic colorectal cancer received 5-fluorouracil (750 mg/m2, daily continuous infusion for days 1-5) and cisplatin (40 mg/m2 1 hour-infusion for days 6-8) given every 4 weeks. Reduced glutathione (2.5 g) was delivered i.v. prior to each cisplatin infusion. Toxicity was minimal and reversible and included nausea/vomiting (11 cases), mild neurotoxicity (4 cases) and leukopenia (2 cases); only 2 patients showed moderate and transient increases of serum creatinine « 2 mg/dl) and BUN. Renal function impairment was also monitored by magnesemia levels and urinary marker enzymes indicating minimal cumulative nephrotoxicity. Out of 10 evaluable patients, only 2 partial responses were observed. The median survival was 9 months (range 5-26). The study was closed, since the preliminary results do not suggest any therapeutic advantage in adding cisplatin to 5-fluorouracil in the present schedule, even using an intensive regimen. Indirect evidence suggests that these disappointing results are not the consequence of interference of GSH on the cytotoxic efficacy of cisplatin. The lack of incidence of severe toxicity of this regimen supports the role of reduced glutathione as a potential protective against cisplatin nephrotoxicity. Although these preliminary results suggest that further studies with the present regimen in this disease are not warranted, in view of its safety this program deserves evaluation in the treatment of neoplastic diseases responsive to 5-fluorouracil/cisplatin.
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Affiliation(s)
- L Cozzaglio
- Istituto Nazionale per lo Studio e la Cura dei Tumori, Milano, Italy
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Marquina G, Manzano A, Casado A. Targeted Agents in Cervical Cancer: Beyond Bevacizumab. Curr Oncol Rep 2018; 20:40. [DOI: 10.1007/s11912-018-0680-3] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Minion LE, Tewari KS. Cervical cancer - State of the science: From angiogenesis blockade to checkpoint inhibition. Gynecol Oncol 2018; 148:609-621. [PMID: 29666026 PMCID: PMC6720107 DOI: 10.1016/j.ygyno.2018.01.009] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 01/07/2018] [Accepted: 01/12/2018] [Indexed: 12/15/2022]
Abstract
Vascular endothelial growth factor (VEGF) has emerged as a therapeutic target in several malignancies, including cervical cancer. Chemotherapy doublets combined with the fully humanized monoclonal antibody, bevacizumab, now constitute first-line therapy for women struggling with recurrent/metastatic cervical carcinoma. Regulatory approval for this indication was based on the phase III randomized trial, GOG 240, which demonstrated a statistically significant and clinically meaningful improvement in overall survival when bevacizumab was added to chemotherapy: 17.0 vs 13.3 months; HR 0.71; 98% CI, 0.54-0.95; p = .004. Incorporation of bevacizumab resulted in significant improvements in progression-free survival and response. These benefits were not accompanied by deterioration in quality of life. GOG 240 identified vaginal fistula as a new adverse event associated with bevacizumab use. All fistulas occurred in women who had received prior pelvic radiotherapy, and none resulted in emergency surgery, sepsis, or death. Final protocol-specified analysis demonstrated continued separation of the survival curves favoring VEGF inhibition: 16.8 vs 13.3 months; HR 0.77; 95% CI, 0.62-9.95; p = .007. Post-progression survival was not significantly different between the arms in GOG 240. Moving forward, immunotherapy has now entered the clinical trial arena to address the high unmet clinical need for effective and tolerable second line therapies in this patient population. Targeting the programmed cell death 1/programmed death ligand 1 (PD-1/PD-L1) pathway using checkpoint inhibitors to break immunologic tolerance is promising. The immunologic landscape involving human papillomavirus-positive head and neck carcinoma and cutaneous squamous cell carcinoma can be informative when considering feasibility of checkpoint blockade in advanced cervical cancer. Phase II studies using anti-PD-1 molecules, nivolumab and pembrolizumab are ongoing, and GOG 3016, the first phase III randomized trial of a checkpoint inhibitor (cemiplimab) in cervical cancer, recently activated. Important considerations in attempts to inhibit the inhibitors include pseudoprogression and post-progression survival, abscopal effects, and immune-related adverse events, including endocrinopathies.
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Affiliation(s)
- Lindsey E Minion
- The Division of Gynecologic Oncology, University of California, Irvine, United States
| | - Krishnansu S Tewari
- The Division of Gynecologic Oncology, University of California, Irvine, United States.
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Banerjee S. Bevacizumab in cervical cancer: a step forward for survival. Lancet 2017; 390:1626-1628. [PMID: 28756904 DOI: 10.1016/s0140-6736(17)31965-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 07/06/2017] [Indexed: 01/19/2023]
Affiliation(s)
- Susana Banerjee
- Gynaecology Unit, Royal Marsden National Health Service Foundation Trust and Division of Clinical Studies, Institute of Cancer Research, Royal Marsden Hospital, London SW3 6JJ, UK.
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Kozaki M, Sakuma S, Kudaka W, Kinjyo Y, Taira Y, Arakaki Y, Shimoji Y, Nakasone T, Nakamoto T, Wakayama A, Ooyama T, Aoki Y. Therapy-free interval has prognostic value in patients with recurrent cervical cancer treated with chemotherapy following definitive concurrent chemoradiotherapy. Arch Gynecol Obstet 2017; 296:997-1003. [DOI: 10.1007/s00404-017-4520-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 09/04/2017] [Indexed: 11/25/2022]
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Neoadjuvant Weekly Paclitaxel-Carboplatin Is Effective in Stage I–II Cervical Cancer. Int J Gynecol Cancer 2017; 27:1256-1260. [DOI: 10.1097/igc.0000000000001021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ObjectiveNeoadjuvant chemotherapy (NACT) followed by surgery in cervical cancer is widely studied with paclitaxel-ifosfamide-cisplatinum 3 weekly (TIP). Although the response rates with TIP are high, the toxicity is substantial. Therefore, this study evaluates dose-dense paclitaxel-carboplatin (TC) as an alternative.MethodsIn this prospective phase 2 study trial, we included 36 patients with International Federation of Gynecology and Obstetrics (FIGO) stage IB1 to IIB cervical cancer, who received 9 weeks’ NACT dose-dense TC (median weekly dose paclitaxel 60 mg/m2, carboplatinum area under the curve 2.7). Radiological response was evaluated by RECIST (Response Evaluation Criteria in Solid Tumors). Optimal pathologic response (OPT) was defined as complete disappearance of tumor (complete response [CR]) or residual disease with less than 3-mm stromal invasion (PR1). Suboptimal pathologic response consisted of persistent residual disease with more than 3-mm stromal invasion (PR2).ResultsNine patients had a FIGO stage IB1 (25%), 7 had stage IB2(19%), 3 had stage IIA (8%), and 17 had stage IIB disease (47%). Evaluation by magnetic resonance imaging after NACT showed 32 RECIST responses (89%) (CR in 11, PR in 21). Patients who were inoperable had insufficient reduction of the tumor to be operable (4 patients), progressive disease (1 patient), or stable disease (1 patient). Thirty patients were suitable for surgery after NACT. Pathology showed OPT in 50% (CR in 10, PR1 in 5). Thirteen patients had pathologic lymph nodes on radiological evaluation before start of chemotherapy. After chemotherapy, the lymph nodes were negative in 6 (47%) of these patients (pathologic complete remission). Postoperative chemoradiotherapy was administered in 11 patients (2 because of close resection margins, 5 because of metastatic lymph node after surgery, 2 because of close resection margins and metastatic lymph nodes after surgery, and 1 tumor >4 cm after NACT). Hematologic toxicity was acceptable with no febrile neutropenia and a low nonhematologic toxicity. The estimated 5-year overall survival was 70.8%.ConclusionsNeoadjuvant TC dose-dense in cervical carcinoma has a high response rate, comparable with TIP, and an acceptable toxicity.
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Phase I Dose-Escalation Study of Weekly Paclitaxel and Cisplatin Followed by Radical Hysterectomy in Stages IB2 and IIA2 Cervical Cancer. Am J Clin Oncol 2017; 40:241-249. [DOI: 10.1097/coc.0000000000000147] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Orang'o E, Itsura P, Tonui P, Muliro H, Rosen B, van Lonkhuijzen L. Use of Palliative Cisplatinum for Advanced Cervical Cancer in a Resource-Poor Setting: A Case Series From Kenya. J Glob Oncol 2016; 3:539-544. [PMID: 29094093 PMCID: PMC5646886 DOI: 10.1200/jgo.2016.006411] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose To evaluate the effectiveness and feasibility of cisplatinum for palliative treatment of advanced cervical cancer in a resource-poor setting. Methods An observational case series is reported from a university teaching hospital in Kenya. All women presenting with advanced cervical cancer and planned for palliative cisplatinum therapy from 2010 to 2014 were included. Women were treated with cisplatinum 50 mg/m2 every 4 weeks in an outpatient setting. Data on tumor stage and symptoms control were prospectively collected in an electronic database. The main outcome measure was control of symptoms such as bleeding, discharge, and pain. Results Of the women who originally presented with bleeding, 62% reported improvement in this symptom, 31.3% reported the bleeding completely stopped, 58% had improvement of their vaginal discharge, and 20.5% reported complete resolution. Of the women who presented with pain, 54% reported improvement; 30.9% reported pain had completely resolved. After each treatment cycle, approximately 30% of patients did not return for their next treatment. Conclusion Cisplatinum as palliative treatment of advanced cervical cancer is feasible in a resource-poor setting and leads to effective symptom control. However, unknown barriers may inhibit women from returning for regular treatment.
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Affiliation(s)
- Elkanah Orang'o
- , , , and , Moi University School of Medicine, Eldoret, Kenya; , Oakland University, Rochester, MI; , Academic Medical Center, Amsterdam, the Netherlands
| | - Peter Itsura
- , , , and , Moi University School of Medicine, Eldoret, Kenya; , Oakland University, Rochester, MI; , Academic Medical Center, Amsterdam, the Netherlands
| | - Philip Tonui
- , , , and , Moi University School of Medicine, Eldoret, Kenya; , Oakland University, Rochester, MI; , Academic Medical Center, Amsterdam, the Netherlands
| | - Hellen Muliro
- , , , and , Moi University School of Medicine, Eldoret, Kenya; , Oakland University, Rochester, MI; , Academic Medical Center, Amsterdam, the Netherlands
| | - Barry Rosen
- , , , and , Moi University School of Medicine, Eldoret, Kenya; , Oakland University, Rochester, MI; , Academic Medical Center, Amsterdam, the Netherlands
| | - Luc van Lonkhuijzen
- , , , and , Moi University School of Medicine, Eldoret, Kenya; , Oakland University, Rochester, MI; , Academic Medical Center, Amsterdam, the Netherlands
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Li Y, Zeng J, Huang M, An J, Bai P, Wu L, Zhang R. A phase 2 study of nanoparticle albumin-bound paclitaxel plus nedaplatin for patients with advanced, recurrent, or metastatic cervical carcinoma. Cancer 2016; 123:420-425. [PMID: 27696395 DOI: 10.1002/cncr.30328] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 08/10/2016] [Accepted: 08/11/2016] [Indexed: 11/09/2022]
Abstract
BACKGROUND Nanoparticle albumin-bound paclitaxel (nab-paclitaxel) and nedaplatin (NDP) are used for the treatment of patients with cervical cancer. However, to the authors' knowledge, the use of this combination regimen among patients with advanced, recurrent, or metastatic cervical cancer has rarely been reported. METHODS Patients with pathologically confirmed, stage IVB (FIGO staging 2009), recurrent or metastatic cervical cancer were eligible. Nab-paclitaxel at a dose of 175 mg/m2 plus NDP at a dose of 80 mg/m2 was administered intravenously every 3 weeks. The primary endpoint of the current study was the objective response rate (ORR). The secondary endpoints were progression-free survival, overall survival, and safety. RESULTS A total of 27 patients were included (5 with late-stage and 22 with recurrent or metastatic disease). The mean age of the patients was 48.26 ± 9.21 years. Of these 27 patients, 25 had squamous cell carcinoma (92.6%). A total of 26 patients completed 92 cycles of chemotherapy, with an average of 3.4 cycles per patient. The ORR was 50.0% (13 of 26 patients). The overall survival was 16.6 months (95% confidence interval, 12.6-20.6 months) and the progression-free survival was 9.1 months (95% confidence interval, 2.4-15.8 months).The ORR of patients with an interval of >12 months from receipt of prior chemotherapy was significantly higher than that of those with a shorter interval (71.4% vs 25.0%; P = .034). The most common adverse effects reported were myelosuppression, gastrointestinal reactions, fatigue, and peripheral neuropathy. The incidence of grade 3 neutropenia was 33.3% (adverse effects were graded on a scale from 0 to 4 according to the National Cancer Institute's Common Terminology Criteria for Adverse Events [version 3.0]). The incidence of grade 3 thrombocytopenia and anemia was 7.4% and 18.5%, respectively. The incidence of grade 1 to 2 peripheral neuropathy was reported to be as high as 51.9%. No case of hypersensitivity was observed. CONCLUSIONS The combination of nab-paclitaxel plus NDP for the treatment of patients with late-stage, recurrent, or metastatic cervical cancer appears to be active and tolerable. Cancer 2017;123:420-425. © 2016 American Cancer Society.
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Affiliation(s)
- Yifan Li
- Department of Gynecological Oncology, Cancer Hospital of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Jing Zeng
- Department of Gynecological Oncology, Cancer Hospital of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Manni Huang
- Department of Gynecological Oncology, Cancer Hospital of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Jusheng An
- Department of Gynecological Oncology, Cancer Hospital of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Ping Bai
- Department of Gynecological Oncology, Cancer Hospital of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Lingying Wu
- Department of Gynecological Oncology, Cancer Hospital of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Rong Zhang
- Department of Gynecological Oncology, Cancer Hospital of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
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