Chemotherapy with AP significantly improved progression-free and overall survival compared with WAI. Nevertheless, further advances in efficacy and reduction in toxicity are clearly needed.

A B S T R A C T PurposeAssess toxicity and efficacy of cisplatin (Cis) doublet combinations in advanced and recurrent cervical carcinoma. Patients and MethodsPatients 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 ϭ 5%). Quality-of-life data were prospectively collected. ResultsA 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. ConclusionVC, 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.