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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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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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Kunos CA, Chu E, Makower D, Kaubisch A, Sznol M, Ivy SP. Phase I Trial of Triapine-Cisplatin-Paclitaxel Chemotherapy for Advanced Stage or Metastatic Solid Tumor Cancers. Front Oncol 2017; 7:62. [PMID: 28421163 PMCID: PMC5378786 DOI: 10.3389/fonc.2017.00062] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 03/20/2017] [Indexed: 02/01/2023] Open
Abstract
Ribonucleotide reductase (RNR) is an enzyme involved in the de novo synthesis of deoxyribonucleotides, which are critical for DNA replication and DNA repair. Triapine is a small-molecule RNR inhibitor. A phase I trial studied the safety of triapine in combination with cisplatin–paclitaxel in patients with advanced stage or metastatic solid tumor cancers in an effort to capitalize on disrupted DNA damage repair. A total of 13 patients with various previously treated cancers were given a 96-h continuous intravenous (i.v.) infusion of triapine (40–120 mg/m2) on day 1, and then 3-h i.v. paclitaxel (80 mg/m2) followed by 1-h i.v. cisplatin (50–75 mg/m2) on day 3. This combination regimen was repeated every 21 days. The maximum tolerated dose (MTD) for each agent was identified to be triapine (80 mg/m2), cisplatin (50 mg/m2), and paclitaxel (80 mg/m2). Common grade 3 or 4 toxicities included reversible anemia, leukopenia, thrombocytopenia, or electrolyte abnormalities. The combination regimen of triapine–cisplatin–paclitaxel resulted in no objective responses; however, five (83%) of six patients treated at the MTD had stable disease between 1 and 8 months duration. This phase I study showed that the combination regimen of triapine–cisplatin–paclitaxel was safe and provides a rational basis for a follow-up phase II trial to evaluate efficacy and progression-free survival in women with metastatic or recurrent uterine cervix cancer.
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Affiliation(s)
- Charles A Kunos
- Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD, USA
| | - Edward Chu
- University of Pittsburgh Cancer Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | | | - Mario Sznol
- Yale University School of Medicine, Yale Cancer Center, New Haven, CT, USA
| | - Susan Percy Ivy
- Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD, USA
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Tsuda N, Watari H, Ushijima K. Chemotherapy and molecular targeting therapy for recurrent cervical cancer. Chin J Cancer Res 2016; 28:241-53. [PMID: 27199523 PMCID: PMC4865618 DOI: 10.21147/j.issn.1000-9604.2016.02.14] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
For patients with primary stage ⅣB, persistent, or recurrent cervical cancer, chemotherapy remains the standard treatment, although it is neither curative nor associated with long-term disease control. In this review, we summarized the history of treatment of recurrent cervical cancer, and the current recommendation for chemotherapy and molecular targeted therapy. Eligible articles were identified by a search of the MEDLINE bibliographical database for the period up to November 30, 2014. The search strategy included the following any or all of the keywords: “uterine cervical cancer”, “chemotherapy”, and “targeted therapies”. Since cisplatin every 21 days was considered as the historical standard treatment for recurrent cervical cancer, subsequent trials have evaluated and demonstrated activity for other agents including paclitaxel, gemcitabine, topotecan and vinorelbine among others. Accordingly, promising agents were incorporated into phase Ⅲ trials. To examine the best agent to combine with cisplatin, several landmark phase Ⅲ clinical trials were conducted by Gynecologic Oncology Group (GOG) and Japan Clinical Oncology Group (JCOG). Through, GOG204 and JCOG0505, paclitaxel/cisplatin (TP) and paclitaxel/carboplatin (TC) are now considered to be the recommended therapies for recurrent cervical cancer patients. However, the prognosis of patients who are already resistant to chemotherapy, are very poor. Therefore new therapeutic strategies are urgently required. Molecular targeted therapy will be the most hopeful candidate of these strategies. From the results of GOG240, bevacizumab combined with TP reached its primary endpoint of improving overall survival (OS). Although, the prognosis for recurrent cervical cancer patients is still poor, the results of GOG240 shed light on the usefulness of molecular target agents to chemotherapy in cancer patients. Recurrent cervical cancer is generally considered incurable and current chemotherapy regiments offer only modest gains in OS, particularly for patients with multiple poor prognostic factors. Therefore, it is crucial to consider not only the survival benefit, but also the minimization of treatment toxicity, and maximization of quality of life (QOL).
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Affiliation(s)
- Naotake Tsuda
- 1Department of Obstetrics and Gynecology, Kurume University School of Medicine, Kurume, Japan
| | - Hidemichi Watari
- 2Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Kimio Ushijima
- 1Department of Obstetrics and Gynecology, Kurume University School of Medicine, Kurume, Japan
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Saeed LM, Mahmood M, Xu Y, Nima ZA, Kannarpady GK, Bratton SM, Dervishi E, Casciano D, Ali S, Crooks PA, Radominska-Pandya A, Biris AS. Nanodelivery of gambogic acid by functionalized graphene enhances inhibition of cell proliferation and induces G0/G1 cell cycle arrest in cervical, ovarian, and prostate cancer cells. RSC Adv 2015. [DOI: 10.1039/c5ra00833f] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Graphene was used to deliver gambogic acid to cervical, ovarian, and prostate cancer cells and the complex was shown to be more effective at inhibiting cell proliferation, initiating cell cycle arrest and inducing apoptosis compared to the drug alone.
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Affiliation(s)
- L. M. Saeed
- Center for Integrative Nanotechnology Sciences
- University of Arkansas at Little Rock
- USA
| | - M. Mahmood
- Center for Integrative Nanotechnology Sciences
- University of Arkansas at Little Rock
- USA
| | - Y. Xu
- Center for Integrative Nanotechnology Sciences
- University of Arkansas at Little Rock
- USA
| | - Z. A. Nima
- Center for Integrative Nanotechnology Sciences
- University of Arkansas at Little Rock
- USA
| | - G. K. Kannarpady
- Center for Integrative Nanotechnology Sciences
- University of Arkansas at Little Rock
- USA
| | - S. M. Bratton
- Department of Biochemistry and Molecular Biology
- College of Medicine at the University of Arkansas for Medical Sciences
- Little Rock
- USA
| | - E. Dervishi
- Center for Integrative Nanotechnology Sciences
- University of Arkansas at Little Rock
- USA
| | - D. Casciano
- Center for Integrative Nanotechnology Sciences
- University of Arkansas at Little Rock
- USA
| | - S. Ali
- National Center for Toxicological Research
- Food and Drug Administration
- Jefferson
- USA
| | - P. A. Crooks
- Department of Pharmaceutical Sciences
- College of Pharmacy
- University of Arkansas for Medical Sciences
- Little Rock
- USA
| | - A. Radominska-Pandya
- Department of Biochemistry and Molecular Biology
- College of Medicine at the University of Arkansas for Medical Sciences
- Little Rock
- USA
| | - A. S. Biris
- Center for Integrative Nanotechnology Sciences
- University of Arkansas at Little Rock
- USA
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Seol HJ, Ulak R, Ki KD, Lee JM. Cytotoxic and targeted systemic therapy in advanced and recurrent cervical cancer: experience from clinical trials. TOHOKU J EXP MED 2014; 232:269-76. [PMID: 24695215 DOI: 10.1620/tjem.232.269] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Cervical cancer is the third most common malignant disease of women worldwide. Despite advances in screening and treatment strategies, a significant number of patients have advanced and recurrent disease. These patients are not amenable to curative treatments, such as surgery and radiation, and have poor prognosis. Therefore, palliative treatment remains the standard of care for these patients. Several phase II/III trials have demonstrated that cisplatin is the most active single agent, and the combination of cisplatin and paclitaxel is considered a standard regimen for clinical practice and trials in these patients with improved response rates and progression-free intervals. Although other cisplatin doublet chemotherapy regimens were not superior to cisplatin plus paclitaxel, substituting topotecan or gemcitabine for paclitaxel might be helpful for some patients considering different toxicity profiles. Because the response to palliative chemotherapy is poor, several targeted agents including bevacizumab, erlotinib, pazopanib, lapatinib, sunitinib and cetuximab, each of which inhibits cell proliferation and angiogenesis, were evaluated in these patients. Of them, bevacizumab, targeting vascular endothelial growth factor, showed favorable results. Recent phase III trial showed that bevacizumab combined with chemotherapy was shown to significantly improve the response rate, progression-free interval, and overall survival compared to chemotherapy alone. These results suggest that targeted agents could significantly improve survival and affect practice guidelines in these patients showing poor prognosis. Thus, future trials using newly developed targeted agents are warranted to improve treatment strategies in these patients.
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Affiliation(s)
- Hyun-Joo Seol
- Department of Obstetrics and Gynecology, School of Medicine, Kyung Hee University
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7
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Miller DS, Blessing JA, Ramondetta LM, Pham HQ, Tewari KS, Landrum LM, Brown J, Mannel RS. Pemetrexed and cisplatin for the treatment of advanced, persistent, or recurrent carcinoma of the cervix: a limited access phase II trial of the gynecologic oncology group. J Clin Oncol 2014; 32:2744-9. [PMID: 25071133 DOI: 10.1200/jco.2013.54.7448] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
PURPOSE To estimate the antitumor activity of pemetrexed and cisplatin with objective tumor response (partial and complete) in patients with advanced, persistent, or recurrent carcinoma of the cervix and to determine the nature and degree of toxicity of this regimen. Secondarily, this study will determine the effects of this regimen on progression-free survival and overall survival. PATIENTS AND METHODS Eligible, consenting patients received pemetrexed 500 mg/m(2) and cisplatin 50 mg/m(2) intravenously repeated every 21 days until disease progression or adverse events prohibited further therapy. Patients received no prior therapeutic chemotherapy, except when administered concurrently with primary radiation therapy. Subsequent doses were adjusted according to observed toxicity and protocol guidelines. Adverse events were assessed with Common Terminology Criteria for Adverse Events v 3.0. The primary measure of efficacy was tumor response according to Response Evaluation Criteria in Solid Tumors. The study was stratified by prior radiation therapy. RESULTS From September 2008 to November 2011, 55 patients were enrolled by five Gynecologic Oncology Group member institutions; of those, 54 patients were eligible and assessable. The regimen was well tolerated with 26% receiving more than nine cycles. The most common greater than grade 2 toxicities were neutropenia 35%, leukopenia 28%, and metabolic 28%. The overall response rate was 31% (one complete and 16 partial). The median progression-free survival was 5.7 months, and overall survival was 12.3 months. CONCLUSION Pemetrexed in combination with cisplatin demonstrates activity in the treatment of advanced, persistent, or recurrent carcinoma of the cervix.
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Affiliation(s)
- David Scott Miller
- David Scott Miller, University of Texas Southwestern Medical Center, Dallas; Lois M. Ramondetta and Jubilee Brown, MD Anderson Cancer Center, Houston, TX; John A. Blessing, Roswell Park Cancer Institute, Buffalo, NY; Huyen Q. Pham, University of Southern California, Los Angeles; Krishnansu S. Tewari, University of California Medical Center at Irvine, Orange, CA; and Lisa M. Landrum and Robert S. Mannel, University of Oklahoma, Oklahoma City, OK.
| | - John A Blessing
- David Scott Miller, University of Texas Southwestern Medical Center, Dallas; Lois M. Ramondetta and Jubilee Brown, MD Anderson Cancer Center, Houston, TX; John A. Blessing, Roswell Park Cancer Institute, Buffalo, NY; Huyen Q. Pham, University of Southern California, Los Angeles; Krishnansu S. Tewari, University of California Medical Center at Irvine, Orange, CA; and Lisa M. Landrum and Robert S. Mannel, University of Oklahoma, Oklahoma City, OK
| | - Lois M Ramondetta
- David Scott Miller, University of Texas Southwestern Medical Center, Dallas; Lois M. Ramondetta and Jubilee Brown, MD Anderson Cancer Center, Houston, TX; John A. Blessing, Roswell Park Cancer Institute, Buffalo, NY; Huyen Q. Pham, University of Southern California, Los Angeles; Krishnansu S. Tewari, University of California Medical Center at Irvine, Orange, CA; and Lisa M. Landrum and Robert S. Mannel, University of Oklahoma, Oklahoma City, OK
| | - Huyen Q Pham
- David Scott Miller, University of Texas Southwestern Medical Center, Dallas; Lois M. Ramondetta and Jubilee Brown, MD Anderson Cancer Center, Houston, TX; John A. Blessing, Roswell Park Cancer Institute, Buffalo, NY; Huyen Q. Pham, University of Southern California, Los Angeles; Krishnansu S. Tewari, University of California Medical Center at Irvine, Orange, CA; and Lisa M. Landrum and Robert S. Mannel, University of Oklahoma, Oklahoma City, OK
| | - Krishnansu S Tewari
- David Scott Miller, University of Texas Southwestern Medical Center, Dallas; Lois M. Ramondetta and Jubilee Brown, MD Anderson Cancer Center, Houston, TX; John A. Blessing, Roswell Park Cancer Institute, Buffalo, NY; Huyen Q. Pham, University of Southern California, Los Angeles; Krishnansu S. Tewari, University of California Medical Center at Irvine, Orange, CA; and Lisa M. Landrum and Robert S. Mannel, University of Oklahoma, Oklahoma City, OK
| | - Lisa M Landrum
- David Scott Miller, University of Texas Southwestern Medical Center, Dallas; Lois M. Ramondetta and Jubilee Brown, MD Anderson Cancer Center, Houston, TX; John A. Blessing, Roswell Park Cancer Institute, Buffalo, NY; Huyen Q. Pham, University of Southern California, Los Angeles; Krishnansu S. Tewari, University of California Medical Center at Irvine, Orange, CA; and Lisa M. Landrum and Robert S. Mannel, University of Oklahoma, Oklahoma City, OK
| | - Jubilee Brown
- David Scott Miller, University of Texas Southwestern Medical Center, Dallas; Lois M. Ramondetta and Jubilee Brown, MD Anderson Cancer Center, Houston, TX; John A. Blessing, Roswell Park Cancer Institute, Buffalo, NY; Huyen Q. Pham, University of Southern California, Los Angeles; Krishnansu S. Tewari, University of California Medical Center at Irvine, Orange, CA; and Lisa M. Landrum and Robert S. Mannel, University of Oklahoma, Oklahoma City, OK
| | - Robert S Mannel
- David Scott Miller, University of Texas Southwestern Medical Center, Dallas; Lois M. Ramondetta and Jubilee Brown, MD Anderson Cancer Center, Houston, TX; John A. Blessing, Roswell Park Cancer Institute, Buffalo, NY; Huyen Q. Pham, University of Southern California, Los Angeles; Krishnansu S. Tewari, University of California Medical Center at Irvine, Orange, CA; and Lisa M. Landrum and Robert S. Mannel, University of Oklahoma, Oklahoma City, OK
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Phase II Trial on Cisplatin-Adriamycin-Paclitaxel Combination as Neoadjuvant Chemotherapy for Locally Advanced Cervical Adenocarcinoma. Int J Gynecol Cancer 2014; 24:729-34. [DOI: 10.1097/igc.0000000000000115] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ObjectiveNeoadjuvant chemotherapy (NACT) followed by surgery is a different therapeutic approach to locally advanced cervical adenocarcinoma (LACA) and seems to offer specific advantages over chemoradiation. This phase II trial was designed to evaluate the toxicity and activity of NACT with cisplatin-adriamycin-paclitaxel (TAP) in patients with LACA.MethodsPatients with International Federation of Gynecology and Obstetrics stage IB2–IIB uterine adenocarcinoma were treated with NACT TAP for 3 cycles. After the last cycle, patients underwent radical surgery with lymph node dissection. Pathological response was classified as no residual tumor (pCR), residual disease with less than 3-mm stromal invasion (pR1), or residual disease with more than 3-mm stromal invasion (pR2).ResultsBetween 2003 and 2010, 30 women were enrolled. Fourteen complete clinical responses, 10 partial responses, and 6 stabilizations of disease were registered. Three patients achieved a pCR, 6 a pR1 response, and 21 a pR2 response. At a median follow-up of 45 months, progression-free survival and overall survival were 37 and 48 months, respectively. Hematologic toxicity was the most relevant adverse effect.ConclusionsThe TAP combination seems to be feasible with an acceptable toxicity profile and a promising response rate for the treatment of LACA.
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Kamura T, Ushijima K. Chemotherapy for advanced or recurrent cervical cancer. Taiwan J Obstet Gynecol 2014; 52:161-4. [PMID: 23915846 DOI: 10.1016/j.tjog.2013.04.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2013] [Indexed: 10/26/2022] Open
Abstract
The primary treatment options for cervical cancer are surgery and radiation for more than a century. However, over the last 40 years chemotherapy has been building up its reputation in the management of cervical cancer in various forms such as chemoradiation, neoadjuvant chemotherapy, and palliative chemotherapy for advanced or recurrent disease. Among these, in this review, chemotherapy for advanced or recurrent cervical cancer will be discussed.
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Affiliation(s)
- Toshiharu Kamura
- Department of Obstetrics and Gynecology, Kurume University School of Medicine, Kurume-Shi, Japan.
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10
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Elit LM, Hirte H. Management of advanced or recurrent cervical cancer: chemotherapy and beyond. Expert Rev Anticancer Ther 2014; 14:319-32. [DOI: 10.1586/14737140.2014.866041] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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11
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Bhattacharya S, Kumar NM, Ganguli A, Tantak MP, Kumar D, Chakrabarti G. NMK-TD-100, a novel microtubule modulating agent, blocks mitosis and induces apoptosis in HeLa cells by binding to tubulin. PLoS One 2013; 8:e76286. [PMID: 24116100 PMCID: PMC3792137 DOI: 10.1371/journal.pone.0076286] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Accepted: 08/22/2013] [Indexed: 11/19/2022] Open
Abstract
Thiadiazoles are one of the most widely utilized agents in medicinal chemistry, having a wide range of pharmacologic activity. Microtubules (MTs) have always remained a sought-after target in rapidly proliferating cancer cells. We screened for the growth inhibitory effect of synthetic 5-(3-indolyl)-2-substituted-1,3,4-thiadiazoles on cancer cells and identified NMK-TD-100, as the most potent agent. Cell viability experiments using human cervical carcinoma cell line (HeLa cells) indicated that the IC50 value was 1.42±0.11 µM for NMK-TD-100 for 48 h treatment. In further study, we examined the mode of interaction of NMK-TD-100 with tubulin and unraveled the cellular mechanism responsible for its anti-tumor activity. NMK-TD-100 induced arrest in mitotic phase of cell cycle, caused decline in mitochondrial membrane potential and induced apoptosis in HeLa cells. Immunofluorescence studies using an anti-α-tubulin antibody showed a significant depolymerization of the interphase microtubule network and spindle microtubule in HeLa cells in a concentration-dependent manner. However, the cytotoxicity of NMK-TD-100 towards human peripheral blood mononuclear cells (PBMC) was lower compared to that in cancer cells. Polymerization of tissue purified tubulin into microtubules was inhibited by NMK-TD-100 with an IC50 value of 17.5±0.35 µM. The binding of NMK-TD-100 with tubulin was studied using NMK-TD-100 fluorescence enhancement and intrinsic tryptophan fluorescence of tubulin. The stoichiometry of NMK-TD-100 binding to tubulin is 1:1 (molar ratio) with a dissociation constant of ~1 µM. Fluorescence spectroscopic and molecular modeling data showed that NMK-TD-100 binds to tubulin at a site which is very near to the colchicine binding site. The binding of NMK-TD-100 to tubulin was estimated to be ~10 times faster than that of colchicine. The results indicated that NMK-TD-100 exerted anti-proliferative activity by disrupting microtubule functions through tubulin binding and provided insights into its potential of being a chemotherapeutic agent.
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MESH Headings
- Amino Acids/chemistry
- Amino Acids/metabolism
- Apoptosis/drug effects
- Blotting, Western
- Caspase 3/metabolism
- Cell Proliferation/drug effects
- Cell Survival/drug effects
- Cells, Cultured
- Dose-Response Relationship, Drug
- HeLa Cells
- Humans
- Indoles/chemistry
- Indoles/metabolism
- Indoles/pharmacology
- Leukocytes, Mononuclear/cytology
- Leukocytes, Mononuclear/drug effects
- Leukocytes, Mononuclear/metabolism
- M Phase Cell Cycle Checkpoints/drug effects
- Membrane Potential, Mitochondrial/drug effects
- Microscopy, Electron
- Microtubules/drug effects
- Microtubules/metabolism
- Mitosis/drug effects
- Models, Molecular
- Molecular Structure
- Protein Binding
- Protein Structure, Tertiary
- Proto-Oncogene Proteins c-bcl-2/metabolism
- Thiadiazoles/chemistry
- Thiadiazoles/metabolism
- Thiadiazoles/pharmacology
- Tubulin/chemistry
- Tubulin/metabolism
- Tubulin/ultrastructure
- Tubulin Modulators/chemistry
- Tubulin Modulators/metabolism
- Tubulin Modulators/pharmacology
- Tumor Suppressor Protein p53/metabolism
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Affiliation(s)
- Surela Bhattacharya
- Department of Biotechnology and Dr. B.C. Guha Centre for Genetic Engineering and Biotechnology, University of Calcutta, Kolkata, India
| | - N. Maruthi Kumar
- Department of Chemistry, Birla Institute of Technology and Science, Pilani, Rajasthan, India
| | - Arnab Ganguli
- Department of Biotechnology and Dr. B.C. Guha Centre for Genetic Engineering and Biotechnology, University of Calcutta, Kolkata, India
| | - Mukund P. Tantak
- Department of Chemistry, Birla Institute of Technology and Science, Pilani, Rajasthan, India
| | - Dalip Kumar
- Department of Chemistry, Birla Institute of Technology and Science, Pilani, Rajasthan, India
- * E-mail: (GC); (DK)
| | - Gopal Chakrabarti
- Department of Biotechnology and Dr. B.C. Guha Centre for Genetic Engineering and Biotechnology, University of Calcutta, Kolkata, India
- * E-mail: (GC); (DK)
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Developments in the systemic treatment of metastatic cervical cancer. Cancer Treat Rev 2013; 39:430-43. [DOI: 10.1016/j.ctrv.2012.05.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Revised: 05/22/2012] [Accepted: 05/27/2012] [Indexed: 11/21/2022]
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Leath CA, Straughn JM. Chemotherapy for advanced and recurrent cervical carcinoma: Results from cooperative group trials. Gynecol Oncol 2013; 129:251-7. [PMID: 23280089 DOI: 10.1016/j.ygyno.2012.12.035] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Revised: 12/17/2012] [Accepted: 12/19/2012] [Indexed: 10/27/2022]
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Gupta AA, Yao X, Verma S, Mackay H, Hopkins L. Systematic chemotherapy for inoperable, locally advanced, recurrent, or metastatic uterine leiomyosarcoma: a systematic review. Clin Oncol (R Coll Radiol) 2013; 25:346-55. [PMID: 23295078 DOI: 10.1016/j.clon.2012.11.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2012] [Revised: 10/15/2012] [Accepted: 10/22/2012] [Indexed: 11/25/2022]
Abstract
The goal of this systematic review was to investigate and compare the treatment effects of systemic chemotherapy (i.e. doxorubicin, gemcitabine, gemcitabine plus docetaxel, or trabectedin) in women with inoperable, locally advanced, recurrent, or metastatic uterine leiomyosarcoma. A 2005 systematic review (searching the literature from 1980 to June 2004) on systemic therapy in advanced uterine sarcoma was used as the basis for this updated review. MEDLINE and EMBASE (from January 2004 to June 2011), the Cochrane Library, some main guideline websites and the American Society of Clinical Oncology and the Connective Tissue Oncology Society annual meeting abstracts were searched. One arm from a randomised controlled trial (RCT), four single-arm phase II trials and one abstract were included in this systematic review. The studies of gemcitabine plus docetaxel have reported numerically longer median overall survival (14.7-17.9 months versus 12.1 months) and numerically higher objective response rates (27-53% versus 25%) than those reported in the study of doxorubicin alone. The combination of gemcitabine plus docetaxel resulted in more toxicity than doxorubicin alone. The available study for single-agent gemcitabine reported a tumour response rate of 21%, which is not superior to the 25% response rate with doxorubicin alone. One abstract (pooling data from two RCTs) failed to show the superiority of gemcitabine plus docetaxel over gemcitabine alone for tumour response rate (23% versus 18%) and progression-free survival (6 versus 4.9 months). To date, there is insufficient evidence to support or refute the use of trabectedin in the target patients. Doxorubicin, gemcitabine, and gemcitabine plus docetaxel are treatment options in women with inoperable, locally advanced, recurrent, or metastatic uterine leiomyosarcoma as first- or second-line therapy. Well-designed and good-quality RCTs are required to investigate the efficacy of chemotherapy and quality of life in target patients with uterine leiomyosarcoma.
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Affiliation(s)
- A A Gupta
- Division of Hematology/Oncology, The Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
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A prospective phase II study of topotecan (Hycamtin®) and cisplatin as neoadjuvant chemotherapy in locally advanced cervical cancer. Gynecol Oncol 2011; 122:285-90. [DOI: 10.1016/j.ygyno.2011.04.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2010] [Revised: 04/10/2011] [Accepted: 04/12/2011] [Indexed: 11/23/2022]
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Geara FB, Shamseddine A, Khalil A, Abboud M, Charafeddine M, Seoud M. A phase II randomized trial comparing radiotherapy with concurrent weekly cisplatin or weekly paclitaxel in patients with advanced cervical cancer. Radiat Oncol 2010; 5:84. [PMID: 20863389 PMCID: PMC2955593 DOI: 10.1186/1748-717x-5-84] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2010] [Accepted: 09/23/2010] [Indexed: 12/27/2022] Open
Abstract
Purpose/Objective This is a prospective comparison of weekly cisplatin to weekly paclitaxel as concurrent chemotherapy with standard radiotherapy for locally advanced cervical carcinoma. Materials/Methods Between May 2000 and May 2004, 31 women with FIGO stage IB2-IVA cervical cancer or with postsurgical pelvic recurrence were enrolled into this phase II study and randomized to receive on a weekly basis either 40 mg/m2 Cisplatin (group I; 16 patients) or 50 mg/m2 paclitaxel (group II; 15 patients) concurrently with radiotherapy. Median total dose to point A was 74 Gy (range: 66-92 Gy) for group I and 66 Gy (range: 40-98 Gy) for group II. Median follow-up time was 46 months. Results Patient and tumor characteristics were similar in both groups. The mean number of chemotherapy cycles was also comparable with 87% and 80% of patients receiving at least 4 doses in groups I and II, respectively. Seven patients (44%) of group I and 8 patients (53%) of group II developed tumor recurrence. The Median Survival time was not reached for Group I and 53 months for group II. The proportion of patients surviving at 2 and 5 years was 78% and 54% for group I and 73% and 43% for group II respectively. Conclusions This small prospective study shows that weekly paclitaxel does not provide any clinical advantage over weekly cisplatin for concurrent chemoradiation for advanced carcinoma of the cervix.
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Affiliation(s)
- Fady B Geara
- Department of Radiation Oncology, The American University of Beirut Medical Center, Bliss Street, Beirut, Lebanon.
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Cella D, Huang HQ, Monk BJ, Wenzel L, Benda J, McMeekin DS, Cohn D, Ramondetta L, Boardman CH. Health-related quality of life outcomes associated with four cisplatin-based doublet chemotherapy regimens for stage IVB recurrent or persistent cervical cancer: a Gynecologic Oncology Group study. Gynecol Oncol 2010; 119:531-7. [PMID: 20837359 DOI: 10.1016/j.ygyno.2010.08.020] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2010] [Revised: 08/01/2010] [Accepted: 08/16/2010] [Indexed: 10/19/2022]
Abstract
PURPOSE To assess the differences in health-related quality of life (HRQL) of 4 cisplatin containing doublet chemotherapy combinations in women with advanced/recurrent cervical carcinoma. METHODS Patients were randomized to three-week cycles of paclitaxel + cisplatin (PC); vinorelbine + C (VC); gemcitabine + C (GC); or topotecan + C (TC). We report HRQL results from data available on 434 eligible patients enrolled into this 513 patient trial. HRQL was assessed with the Functional Assessment of Cancer Therapy-Cervix (FACT-Cx) the FACT/Gynecologic Oncology Group (FACT/GOG) four-item neurotoxicity scale, and the 0-10 "worst pain" item from the Brief Pain Inventory, at baseline (pre-treatment), prior to beginning cycle 2, prior to beginning cycle 5, and at 9 months after enrollment. As reported by Monk et al. (2009) [13] VC, GC and TC were found not to be superior to PC with regard to progression-free survival or overall survival. RESULTS The trial was terminated early due to planned interim futility analysis, reducing power for HRQL analysis from 85% to 55%. Patients receiving VC, GC and TC doublets did not report significantly different HRQL, neuropathy, or pain from those who received the PC (control) doublet. Patients receiving PC tended to report worse neuropathy during treatment than patients who received other doublets (especially GC and TC), but the differences were not statistically significant. CONCLUSION None of the 3 experimental doublets was different from PC in terms of HRQL during treatment. Long-term toxicity data are inconclusive. Except where patients may wish to reduce their risk of worsening pre-treatment neuropathy, PC remains the standard of care for this disease.
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Affiliation(s)
- David Cella
- Northwestern University Feinberg School of Medicine, Robert H. Lurie Comprehensive Cancer Center, Chicago, IL, USA.
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Dueñas-González A, Cetina L, Coronel J, Martínez-Baños D. Pharmacotherapy options for locally advanced and advanced cervical cancer. Drugs 2010; 70:403-32. [PMID: 20205484 DOI: 10.2165/11534370-000000000-00000] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Cervical cancer continues to be a significant health burden worldwide. Globally, the majority of cancers are locally advanced at diagnosis; hence, radiation remains the most frequently used therapeutic modality. Currently, the value of adding cisplatin or cisplatin-based chemotherapy to radiation for the treatment of locally advanced cervical cancer is strongly supported by randomized studies and meta-analyses. Nevertheless, despite these significant achievements, therapeutic results are far from optimal; thus, novel therapies need to be investigated. A recent, randomized, phase III trial has shown for the first time that combination chemotherapy with cisplatin and gemcitabine concurrently with radiation improves parameters of survival over cisplatin alone and establishes a new standard for the management of locally advanced cervical cancer. On the other hand, advanced disease, presenting either as an International Federation of Gynecology and Obstetrics (FIGO) stage IVB or as persistent or recurrent to primary therapy without local curative options, remains a devastating group of diseases with no options other than palliative chemotherapy. Recent results from the GOG (Gynecologic and Oncologic Group)-204 study demonstrate that cisplatin-doublets with paclitaxel, vinorelbine, gemcitabine or topotecan only produce small improvements in survival, although with different toxicity patterns; hence, patient-related factors are important when choosing any one of these regimens. The role of targeted therapies both in locally advanced and advanced disease is promising, but still at an investigational stage.
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Affiliation(s)
- Alfonso Dueñas-González
- Unidad de Investigación Biomédica en Cáncer, Instituto Nacional de Cancerología/Instituto de Investigaciones Biomédicas (INCan/IIBM), Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico.
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20
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Lorusso D, Ferrandina G, Pignata S, Ludovisi M, Viganò R, Scalone S, Scollo P, Breda E, Pietragalla A, Scambia G. Evaluation of pemetrexed (Alimta, LY231514) as second-line chemotherapy in persistent or recurrent carcinoma of the cervix: the CERVIX 1 study of the MITO (Multicentre Italian Trials in Ovarian Cancer and Gynecologic Malignancies) Group. Ann Oncol 2010; 21:61-6. [DOI: 10.1093/annonc/mdp266] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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21
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Monk BJ, Sill MW, McMeekin DS, Cohn DE, Ramondetta LM, Boardman CH, Benda J, Cella D. Phase III trial of four cisplatin-containing doublet combinations in stage IVB, recurrent, or persistent cervical carcinoma: a Gynecologic Oncology Group study. J Clin Oncol 2009; 27:4649-55. [PMID: 19720909 DOI: 10.1200/jco.2009.21.8909] [Citation(s) in RCA: 442] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Assess toxicity and efficacy of cisplatin (Cis) doublet combinations in advanced and recurrent cervical carcinoma. PATIENTS AND METHODS Patients were randomly assigned to paclitaxel 135 mg/m(2) over 24 hours plus Cis 50 mg/m(2) day 2 every 3 weeks (PC, reference arm); vinorelbine 30 mg/m(2) days 1 and 8 plus Cis 50 mg/m(2) day 1 every 3 weeks (VC); gemcitabine 1,000 mg/m(2) day 1 and 8 plus Cis 50 mg/m(2) day 1 every 3 weeks (GC); or topotecan 0.75 mg/m(2) days 1, 2, and 3 plus Cis 50 mg/m(2) day 1 every 3 weeks (TC). Survival was the primary end point with a 33% improvement relative to PC considered important (85% power, alpha = 5%). Quality-of-life data were prospectively collected. RESULTS A total of 513 patients were enrolled when a planned interim analysis recommended early closure for futility. The experimental-to-PC hazard ratios of death were 1.15 (95% CI, 0.79 to 1.67) for VC, 1.32 (95% CI, 0.91 to 1.92) for GC, and 1.26 (95% CI, 0.86 to 1.82) for TC. The hazard ratios for progression-free survival (PFS) were 1.36 (95% CI, 0.97 to 1.90) for VC, 1.39 (95% CI, 0.99 to 1.96) for GC, and 1.27 (95% CI, 0.90 to 1.78) for TC. Response rates (RRs) for PC, VC, GC, and TC were 29.1%, 25.9%, 22.3%, and 23.4%, respectively. The arms were comparable with respect to toxicity except for leucopenia, neutropenia, infection, and alopecia. CONCLUSION VC, GC, and TC are not superior to PC in terms of overall survival (OS). However, the trend in RR, PFS, and OS favors PC. Differences in chemotherapy scheduling, pre-existing morbidity, and toxicity are important in individualizing therapy.
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Affiliation(s)
- Bradley J Monk
- University of California, Irvine Medical Center, Orange, CA 92868, USA.
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Movva S, Rodriguez L, Arias-Pulido H, Verschraegen C. Novel chemotherapy approaches for cervical cancer. Cancer 2009; 115:3166-80. [DOI: 10.1002/cncr.24364] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Pectasides D, Fountzilas G, Papaxoinis G, Pectasides E, Xiros N, Sykiotis C, Koumarianou A, Psyrri A, Panayiotides J, Economopoulos T. Carboplatin and Paclitaxel in Metastatic or Recurrent Cervical Cancer. Int J Gynecol Cancer 2009; 19:777-81. [DOI: 10.1111/igc.0b013e3181a40a8b] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Pectasides D, Kamposioras K, Papaxoinis G, Pectasides E. Chemotherapy for recurrent cervical cancer. Cancer Treat Rev 2008; 34:603-13. [PMID: 18657909 DOI: 10.1016/j.ctrv.2008.05.006] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2008] [Revised: 05/07/2008] [Accepted: 05/07/2008] [Indexed: 11/18/2022]
Abstract
PURPOSE Cervical cancer is the second most common cancer of women worldwide and one of the leading cause of death in relative young women. This review gives an outline of chemotherapy of advanced, persistent or recurrent cervical cancer. METHODS We performed a literature search in the PubMed of almost all relevant articles concerning chemotherapy of advanced, persistent or recurrent cervical cancer. RESULTS The available data from the literature is mainly composed of most recent reviews, phase II and randomized phase III clinical trials. CONCLUSION Single-agent cisplatin remains the current standard therapy for advanced, persistent or recurrent cervical cancer. Several single-agents have been tested, but none has been found to be superior compared to cisplatin. Both topotecan and paclitaxel in combination with cisplatin, have yielded superior response rates and progression-free survival without diminishing patient quality of life. However, only the combination of cisplatin and topotecan has improved overall survival. It is important to identify clinical and tumor-related factors predictive of response to cisplatin-based chemotherapy. Future trials are necessary, not only to compare combinations of existing agents, but to incorporate biological agents (monoclonal antibodies or small molecules) to chemotherapy in order to improve the treatment results of advanced, persistent or recurrent cervix cancer.
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Affiliation(s)
- D Pectasides
- Second Department of Internal Medicine, Propaedeutic, Oncology Section, University of Athens, Attikon University Hospital, Haidari, 1 Rimini, Athens, Greece.
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Hunter MI, Tewari K, Monk BJ. Cervical neoplasia in pregnancy. Part 2: current treatment of invasive disease. Am J Obstet Gynecol 2008; 199:10-8. [PMID: 18585521 DOI: 10.1016/j.ajog.2007.12.011] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2007] [Revised: 12/13/2007] [Accepted: 12/19/2007] [Indexed: 11/18/2022]
Abstract
Although the incidence of cervical cancer in the United States has declined sharply, many young women are diagnosed with the disease every year. Naturally, coincident pregnancies will occur in this subset of reproductively active patients. Although the treatment of cervical cancer has evolved under the drive of multicenter, randomized trials, the same level of evidence does not exist for the treatment of this malignancy in pregnancy. Treatment algorithms are therefore proposed as a series of modifications to the guidelines intended for the nonpregnant patient, taking into account the tremendous social, ethical, and emotional dilemmas specific to each trimester at presentation.
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Affiliation(s)
- Mark I Hunter
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of California, Irvine, Irvine, CA, USA
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26
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Miller DS, Blessing JA, Bodurka DC, Bonebrake AJ, Schorge JO. Evaluation of pemetrexed (Alimta, LY231514) as second line chemotherapy in persistent or recurrent carcinoma of the cervix: a phase II study of the Gynecologic Oncology Group. Gynecol Oncol 2008; 110:65-70. [PMID: 18455781 DOI: 10.1016/j.ygyno.2008.03.009] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2008] [Revised: 03/05/2008] [Accepted: 03/20/2008] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To estimate the anti-tumor activity of pemetrexed in patients with advanced or recurrent carcinoma of the cervix that failed on higher priority treatment protocols and to determine the nature and degree of toxicity. METHODS A multicenter Phase II trial was conducted by the Gynecologic Oncology Group (GOG). Patients must have had advanced or recurrent measurable carcinoma of the cervix, and failed one prior chemotherapy regimen. Pemetrexed at a dose of 900 mg/m(2) was to be administered as an IV infusion over 10 min every 21 days. RESULTS From July 6, 2004 to April 3, 2006, twenty-nine patients were entered by ten member institutions of the GOG. Two patients did not receive treatment and thus were inevaluable. A total of 128 cycles were administered with 37% of patients receiving six or more cycles. The treatment was well tolerated overall. More serious toxicities (grade 3 and 4) included anemia in 41%, leukopenia in 30%, neutropenia in 26%, and infection in 26%. No treatment related deaths were reported. Four patients (15%) had partial responses with a median response duration of 4.4 months. The response rate for non-radiated or radiated disease sites was 25% and 7% respectively. Sixteen patients (59%) had stable disease and seven (26%) patients had increasing disease. Median progression free survival (PFS) was 3.1 months and overall survival (OS) was 7.4 months. CONCLUSION Pemetrexed at this dose and schedule showed moderate activity against advanced or recurrent cervical cancer that has failed prior chemotherapy. Data from other tumor sites has suggested synergy between pemetrexed and cisplatin and should be considered for further study.
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Affiliation(s)
- David Scott Miller
- University of Texas Southwestern Medical Center at Dallas, TX 75390-9032, USA.
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27
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Goncalves A, Fabbro M, Lhommé C, Gladieff L, Extra JM, Floquet A, Chaigneau L, Carrasco AT, Viens P. A phase II trial to evaluate gefitinib as second- or third-line treatment in patients with recurring locoregionally advanced or metastatic cervical cancer. Gynecol Oncol 2008; 108:42-6. [DOI: 10.1016/j.ygyno.2007.07.057] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2007] [Revised: 07/11/2007] [Accepted: 07/16/2007] [Indexed: 10/22/2022]
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28
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Cadron I, Van Gorp T, Amant F, Leunen K, Neven P, Vergote I. Chemotherapy for recurrent cervical cancer. Gynecol Oncol 2007; 107:S113-8. [PMID: 17804044 DOI: 10.1016/j.ygyno.2007.07.004] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2007] [Accepted: 07/06/2007] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To give an overview of chemotherapy schemes used in recurrent cervical cancer. METHODS A pubmed search was performed using chemotherapy and recurrent cervical cancer including articles until April 2007. RESULTS Most recent articles and articles of interest are discussed. CONCLUSION Single agent cisplatin (50 mg/m2) remains the current standard for recurrent cervical cancer. Numerous chemotherapeutic agents have been tested but did not show convincing evidence of improved survival rates, except for the GOG 179 study which showed an improved survival for the combination of cisplatin and topotecan compared with single agent cisplatin. However, nearly 60% of patients in both groups received prior cisplatinum therapy as a radiosensitizer, which could be responsible for the development of platinum resistance, causing lower response and survival rates in the single platinum group. Hence, the apparent benefit in the doublet group is maybe just a reflection from the change in primary therapy and patient population. It is hoped that current trials comparing standard therapy with other single or doublet chemotherapeutic regimens or that the use of molecular-targeted agents will give us promising therapeutic options in the future.
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Affiliation(s)
- Isabelle Cadron
- Division of Gynecological Oncology, Department of Obstetrics and Gynecology, University Hospitals Leuven, Gasthuisberg, B-3000 Leuven, Katholieke Universiteit Leuven, Belgium
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29
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Maluf FC, Leiser AL, Aghajanian C, Sabbatini P, Pezzulli S, Chi DS, Wolf JK, Levenback C, Loh E, Spriggs DR. Phase II study of tirapazamine plus cisplatin in patients with advanced or recurrent cervical cancer. Int J Gynecol Cancer 2007; 16:1165-71. [PMID: 16803501 DOI: 10.1111/j.1525-1438.2006.00454.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The aim of this study was to evaluate the activity and toxicity of a tirapazamine (TPZ)/cisplatin drug combination in patients with stage IV or recurrent cervical cancer. The chemotherapy was administered for a maximum of eight cycles every 21 days. TPZ was administered intravenously at 330 mg/m(2) over a 2-h infusion, followed 1 h later by cisplatin intravenously at 75 mg/m(2) over 1 h on day 1. All patients received antiemetics including dexamethasone, ondansetron, and lorazepam. Subsequent doses were unchanged, reduced, or omitted according to observed toxicity and protocol guidelines. Response evaluation was performed every two cycles. Thirty-six patients with stage IV or recurrent cervical cancer were treated. Ninety-four percent of patients had prior radiotherapy. Two patients had prior chemotherapy. There were two complete responses and eight partial responses (27.8%). An additional 11 patients (30.6%) had stable disease as their best response. Response rate was greater in tumors outside of the previously radiated field (44.4% vs 11.1%). The median time to progression was 32.7 weeks. The most frequent grade 3 or 4 adverse events were nausea, vomiting, and fatigue, which occurred in 30.6%, 25%, and 22% of subjects, respectively. Anemia was the most frequent grade 3 or 4 hematologic toxicity at 8.3%. We conclude that the combination of cisplatin and TPZ was reasonably well tolerated in patients with recurrent or advanced cervical cancer. Further evaluation of this drug combination may be warranted.
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Affiliation(s)
- F C Maluf
- Developmental Chemotherapy Service and Gynecologic Oncology Service, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA
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30
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Matulonis UA, Campos S, Duska L, Krasner CN, Atkinson T, Penson RT, Seiden MV, Verrill C, Fuller AF, Goodman A. Phase I/II dose finding study of combination cisplatin and gemcitabine in patients with recurrent cervix cancer. Gynecol Oncol 2006; 103:160-4. [PMID: 16566993 DOI: 10.1016/j.ygyno.2006.02.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2005] [Revised: 01/30/2006] [Accepted: 02/08/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To evaluate the toxicity and efficacy of cisplatin and gemcitabine in women with recurrent cervical cancer. METHODS A multi-institutional phase I/II dose finding study of cisplatin and gemcitabine delivered to women with recurrent previously radiated cervical carcinoma. RESULTS Twenty eight patients were enrolled. The mean and median age of patients was 51 years (age range 35 to 70 years). Chemotherapy was given on a 28-day cycle; cisplatin was administered at a fixed dose of 50 mg/m(2), day 1 and gemcitabine, days 1, 8, and 15. Gemcitabine doses started at 600 mg/m(2) (dose level 1) and were escalated by 100 mg/m(2)/dose level until 1000 mg/m(2) (dose level 5). Twenty seven patients were evaluable for toxicity and disease response, and 75 cycles of chemotherapy were administered. Toxicities were predominantly hematological; 18% of patients experienced grade 3 anemia, 37% grade 3 and 11% grade 4 leukopenia, 41% grade 3 neutropenia, and 26% grade 3 thrombocytopenia. The maximally tolerated dose (MTD) was not reached. One patient experienced a dose-limiting toxicity on dose level 2 (febrile neutropenia). One patient had a CR and 3 patients had a PR to therapy (15% response rate), 41% of patients had SD, and 44% had progression of cancer. Median survival was 11.9 months. CONCLUSION Although this 28-day gemcitabine and cisplatin regimen in recurrent cervix cancer has tolerable toxicity, 21-day regimens are recommended because of improved practicality, higher dose intensity, and higher response rates.
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Affiliation(s)
- U A Matulonis
- Division of Medical Oncology, Dana Farber Cancer Institute, 44 Binney Street, Boston, MA 02114, USA.
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31
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Rose PG. Concurrent chemoradiation for locally advanced carcinoma of the cervix: where are we in 2006? Ann Oncol 2006; 17 Suppl 10:x224-9. [PMID: 17018728 DOI: 10.1093/annonc/mdl264] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Affiliation(s)
- P G Rose
- Division of Gynecologic Oncology, Cleveland Clinic Foundation, Case Western Reserve University, Cleveland, Ohio, USA
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Abstract
PURPOSE OF REVIEW If chemotherapy becomes the only treatment option for cervical cancer, the prognosis has traditionally been regarded as dismal. Data from several recent trials have demonstrated significant improvements in outcome with specific cisplatin-containing combinations. The purpose of this review is to highlight the evolution of phase III trials leading to current treatment standards. RECENT FINDINGS Given the modest activity of single-agent cisplatin, devoid of any meaningful impact on survival, prospective studies focused on other drugs that might prove either more effective than, or could be used in combination with, cisplatin. Both paclitaxel and topotecan, in combination with cisplatin, yielded superior response rates and progression-free survival without diminishing patient-reported quality of life; however, only cisplatin plus topotecan also improved overall survival. Furthermore, patient-reported quality of life is not diminished despite the greater acute toxicity of combination regimens. SUMMARY Despite these chemotherapeutic advances, median survival is still less than one year and most patients do not respond to treatment. It is important that investigators identify those patients who should participate in investigational trials of non-platinum-containing regimens. The next generation of clinical trials should explore emerging biological therapies.
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Affiliation(s)
- David H Moore
- Gynecologic Oncology of Indiana, Indianapolis, Indiana 46237, USA.
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Tewari KS, Monk BJ. Gynecologic oncology group trials of chemotherapy for metastatic and recurrent cervical cancer. Curr Oncol Rep 2005; 7:419-34. [PMID: 16221379 DOI: 10.1007/s11912-005-0007-z] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Because only 16% of patients with metastatic cervical cancer are alive 5 years after diagnosis, the Gynecologic Oncology Group (GOG) has carefully designed and conducted many phase II studies to identify promising drugs. Cisplatin has emerged as the most active single agent with overall response rates of 19%. Recent phase III trials have documented response rates of 27% and 39% when cisplatin has been combined with either paclitaxel or topotecan, respectively. The comparison of cisplatin to cisplatin plus topotecan in GOG-179 has yielded the first study to show a statistically significant impact on the overall response rate, median progression-free survival, and median survival, with all outcome measures favoring the two-drug regimen. Despite these encouraging results, however, most of the responses are partial and of short duration. The need for novel combinations and the implementation of active biologic agents is implicit. The accumulated data in this disease setting, as evidenced by the experience of the GOG, are presented in this review.
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Affiliation(s)
- Krishnansu S Tewari
- Division of Gynecologic Oncology, The Chao Family Comprehensive Cancer Center, University of California, Irvine Medical Center, 101 The City Drive, Building 56, Room 262, Orange, CA 92868-3298, USA
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Tinker AV, Bhagat K, Swenerton KD, Hoskins PJ. Carboplatin and paclitaxel for advanced and recurrent cervical carcinoma: the British Columbia Cancer Agency experience. Gynecol Oncol 2005; 98:54-8. [PMID: 15904950 DOI: 10.1016/j.ygyno.2005.03.037] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2004] [Revised: 03/22/2005] [Accepted: 03/31/2005] [Indexed: 11/19/2022]
Abstract
BACKGROUND One of the most active chemotherapy combinations in advanced or recurrent cervical cancer is cisplatin-paclitaxel. However, this palliative regimen is associated with significant toxicity. Carboplatin-paclitaxel is thus an attractive option. METHODS Patients with advanced or recurrent carcinoma of the cervix treated with carboplatin-paclitaxel from April 2000 were included in the study. Starting doses of carboplatin-paclitaxel were: AUC 5-6 and 155-175 mg/m(2), respectively, repeated every 28 days. RESULTS Twenty-five women treated with this combination were identified. Twenty-three women (92%) had prior treatment with pelvic radiotherapy and 14 (56%) had had concurrent radio-sensitizing cisplatin. There was a 20% PR and a 20% CR rate (10/25). The median progression-free survival for the entire group was 3 months. Responders had a median PFS of 16 months. Fourteen patients (56%) had died of disease progression. The median overall survival (OS) was 21 months. Common toxicities included: grade 1 or 2 anemia, 68%; grade 3 or 4 anemia, 32%; grade 3 or 4 neutropenia, 32%; and grade 1 or 2 peripheral neuropathy, 24%. ECOG PS did not change significantly while on treatment. Eighty-four percent of treatments were delivered on time, and 96% at full dose. CONCLUSIONS Carboplatin-paclitaxel is an active combination in advanced and recurrent cervical cancer. In this predominantly pre-irradiated group, the combination was deliverable, well tolerated, and the most commonly observed toxicity was anemia.
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Affiliation(s)
- A V Tinker
- Peter MacCallum Cancer Centre, East Melbourne, Australia.
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