Management of patients with recurrent/advanced cervical cancer beyond first line platinum regimens: Where do we stand? A literature review

Boussios, Stergios; Seraj, Esmeralda; Zarkavelis, George; Petrakis, Dimitrios; Kollas, Aristomenes; Kafantari, Aikaterini; A, Assi; Tatsi, Konstantina; Pavlidis, Nicholas; Pentheroudakis, George

doi:10.1016/j.critrevonc.2016.11.006

Cited by 161 publications

(140 citation statements)

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“…Bevacizumab and doublet chemotherapy (paclitaxel and cisplatin or paclitaxel and topotecan) were adopted as first-line (1L) standard-ofcare therapy for recurrent or metastatic cervical cancer in the past 5 years (4-6). However, nearly all patients relapse after 1L treatment, and single-institution experiences indicate that the percentage of patients who receive a second-line (2L) therapy varies (30%-70%) as many patients die before receiving treatment (7,8).Available 2Lþ therapies for recurrent or metastatic cervical cancer are characterized by low response rates (5,6). Before adoption of bevacizumab plus doublet chemotherapy in 1L, therapies administered in the 2Lþ setting reported response rates in the range of 4.5% to 15%, with median survival of <8 months (9-15).…”

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confidence: 99%

Tisotumab Vedotin in Previously Treated Recurrent or Metastatic Cervical Cancer

Hong

Concin

Vergote

et al. 2020

Clinical Cancer Research

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◥Purpose: Tissue factor (TF) is a potential target in cervical cancer, as it is frequently highly expressed and associated with poor prognosis. Tisotumab vedotin, a first-in-class investigational antibody-drug conjugate targeting TF, has demonstrated encouraging activity in solid tumors. Here we report data from the cervical cancer cohort of innovaTV 201 phase I/II study (NCT02001623).Patients and Methods: Patients with recurrent or metastatic cervical cancer received tisotumab vedotin 2.0 mg/kg every 3 weeks until progressive disease, unacceptable toxicity, or consent withdrawal. The primary objective was safety and tolerability. Secondary objectives included antitumor activity.Results: Of the 55 patients, 51% had received !2 prior lines of treatment in the recurrent or metastatic setting; 67% had prior bevacizumab þ doublet chemotherapy. Fifty-one percent of patients had squamous cell carcinoma. The most common grade 3/4 treatment-emergent adverse events (AEs) were anemia (11%), fatigue (9%), and vomiting (7%). No grade 5 treatment-related AEs occurred. Investigator-assessed confirmed objective response rate (ORR) was 24% [95% confidence interval (CI): 13%À37%]. Median duration of response (DOR) was 4.2 months (range: 1.0 þ À9.7); four patients responded for >8 months. The 6-month progression-free survival (PFS) rate was 29% (95% CI: 17%À43%). Independent review outcomes were comparable, with confirmed ORR of 22% (95% CI: 12%À35%), median DOR of 6.0 months (range: 1.0 þ À9.7), and 6-month PFS rate of 40% (95% CI: 24%À55%). Tissue factor expression was confirmed in most patients; no significant association with response was observed.Conclusions: Tisotumab vedotin demonstrated a manageable safety profile and encouraging antitumor activity in patients with previously treated recurrent or metastatic cervical cancer.Cervical cancer is a common cancer in women, with an estimated 570,000 new cases globally in 2018, and represents the third leading cause of cancer-related death in women worldwide (1). Approximately 15,500 and 61,000 new cases of cervical cancer were estimated in North America and in Europe in 2018, respectively, resulting in approximately 5,800 and 25,800 deaths (2). Recurrent or metastatic cervical cancer has a poor prognosis, with a 5-year survival rate of 17% (3). Bevacizumab and doublet chemotherapy (paclitaxel and cisplatin or paclitaxel and topotecan) were adopted as first-line (1L) standard-ofcare therapy for recurrent or metastatic cervical cancer in the past 5 years (4-6). However, nearly all patients relapse after 1L treatment, and single-institution experiences indicate that the percentage of patients who receive a second-line (2L) therapy varies (30%-70%) as many patients die before receiving treatment (7,8).Available 2Lþ therapies for recurrent or metastatic cervical cancer are characterized by low response rates (5,6). Before adoption of bevacizumab plus doublet chemotherapy in 1L, therapies administered in the 2Lþ setting reported response rates in the range of 4.5% to 15%, with median s...

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confidence: 99%

Tisotumab Vedotin in Previously Treated Recurrent or Metastatic Cervical Cancer

Hong

Concin

Vergote

et al. 2020

Clinical Cancer Research

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“…Generally, non-platinum single agent chemotherapies are used (ie, weekly paclitaxel, gemcitabine, vinorelbine, ifosfamide and irinotecan), with overall response rates ranging from 10–20% and a median survival period of 2–6 months 9. Capecitabine is an oral fluorouracil pro-drug that is enzymatically converted to 5-fluorouracil in the tumor, where it inhibits DNA synthesis and slows tumor growth 10.…”

Section: Introductionmentioning

confidence: 99%

Capecitabine in patients with platinum-pretreated advanced or recurrent cervical carcinoma: a retrospective study

Maltese

Lepori

Sabatucci

et al. 2019

Int J Gynecol Cancer

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BackgroundCervical cancer is a common malignancy among women and, when recurring, presents a dismal prognosis. After platinum failure, second-line treatments report response rates ranging from 3–15%, a median progression-free survival of about 3 months and a median overall survival of about 5.5 months.To retrospectively evaluate the activity and safety of capecitabine in patients with advanced/recurrent cervical carcinoma.MethodsA retrospective review of medical records of recurrent cervical cancer patients, who had failed a previous platinum–paclitaxel treatment and received oral capecitabine 1250 mg/m2 twice daily continuously from day 1 to day 14 every 21 days, was performed from December 2013 to March 2018 at the Gynecologic Oncology Unit of the Fondazione IRCCS National Cancer Institute of Milan, Italy. The response rate was evaluated every three cycles according to Response Evaluation Criteria In Solid Tumors (RECIST) version 1.1 criteria. Common Terminology Criteria for Adverse Events version 4.0 were used to evaluate adverse events.ResultsWe retrospectively analyzed 35 patients with recurrent cervical carcinoma, treated with oral capecitabine. All patients had previously received and failed a combination of carboplatin plus paclitaxel as first-line therapy for advanced/recurrent disease. Median age at the first capecitabine administration was 53 years (range 27–82). All patients were evaluable for response: the overall response rate was 34.2% (2.8% complete responses and 31.4% partial responses) with a clinical benefit rate of 57% (overall response rate plus 22.8% stabilizations of disease). The most common grade 1–2 adverse events per patient were fatigue (71.3%), hand-foot syndrome (57.0%), diarrhea (31.3%), constipation (17.0%), and nausea (10.4%). Only three patients (8.5%) reported grade 3 adverse events.ConclusionsOur data suggest that oral capecitabine should be considered an active and safe treatment in patients with recurrent cervical carcinoma after platinum failure. Based on these results, we consider capecitabine as warranting further clinical evaluation.

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“…Cisplatin is still an option as a single agent in recurrent or metastatic cervical cancer with an overall response rate (ORR) ranging between 13% and 23%. 6 …”

Section: Introductionmentioning

confidence: 99%

Pembrolizumab in cervical cancer: latest evidence and clinical usefulness

Borcoman

Tourneau

2017

Ther Adv Med Oncol

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Cervical cancer is the fourth most common cause of cancer-related deaths in women worldwide. With the development of detection of precancerous lesions and preventive human papillomavirus (HPV) vaccination program, a survival improvement has been observed in these patients in developed countries, although disparities in accessibility to treatments exist across countries. While early-stage cervical cancer can be curable with surgery, prognosis of patients who recur remains poor, with limited treatment options. In this latter setting, recently, bevacizumab, an antiangiogenic monoclonal antibody targeting vascular endothelial growth factor (VEGF), has been shown to improve overall survival in combination with chemotherapy as compared with chemotherapy alone. No standard treatments exist beyond this treatment regimen. New effective treatments are therefore much needed in this setting. Immunotherapy has represented a breakthrough in recent years in oncology, with antitumor activity reported with immune-checkpoint inhibitors in a variety of tumor types. We discuss here the latest evidence and clinical usefulness of pembrolizumab, anti-PD-1 checkpoint inhibitor, in the treatment of advanced cervical cancer.

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Management of patients with recurrent/advanced cervical cancer beyond first line platinum regimens: Where do we stand? A literature review

Cited by 161 publications

References 127 publications

Tisotumab Vedotin in Previously Treated Recurrent or Metastatic Cervical Cancer

Tisotumab Vedotin in Previously Treated Recurrent or Metastatic Cervical Cancer

Capecitabine in patients with platinum-pretreated advanced or recurrent cervical carcinoma: a retrospective study

Pembrolizumab in cervical cancer: latest evidence and clinical usefulness

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