Systemic therapy for cervical carcinoma – current status

Abstract

Two major treatment modalities in cervical cancer are radiation therapy (RT) and surgery. Chemotherapy continues to be the main form of systemic therapy adjunctive to definitive local therapies, and is used for palliation. Platinum-based regimens, administered concurrently with both definitive and postoperative RT, were demonstrated to provide significant survival benefits, whereas the beneficial effect of concurrent chemoradiotherapy in later-stage disease was smaller. The role of chemotherapy in addition to RT in IB1/IIA1 cervical cancer patients not undergoing surgery remains undefined. Likewise, the role of chemotherapy in combination with postoperative RT for patients with intermediate-risk factors for recurrence has not yet been verified. The recent standard for chemoradiotherapy is cisplatin alone administered weekly. Other cisplatin-based or non-cisplatin-based regimens have not been subjected to large clinical studies. The benefits of consolidation chemotherapy after chemoradiation for locally advanced cervical cancer are still undetermined. Neoadjuvant cisplatin-based chemotherapy followed by surgery has shown survival benefits, however its role in the era of chemoradiotherapy remains unclear. The combination of cisplatin and paclitaxel is considered a standard regimen in the palliative setting. There is no standard of care for second-line systemic therapy in advanced cervical cancer. Bevacizumab combined with palliative chemotherapy (cisplatin/paclitaxel or topotecan/paclitaxel) in the first-line treatment for recurrent/metastatic cervical cancer significantly improves overall survival when compared to chemotherapy alone. The role of immunotherapy in cervical cancer remains to be established. The optimal combined modality treatment including systemic therapy for cervical tumors of non-squamous histology remains a matter of debate. Ongoing accumulation of data on genomic and proteomic characteristics provides insight into the molecular heterogeneity of cervical cancer and paves the way for developing molecularly targeted therapies.

Local Radiotherapy or Chemotherapy for Oligo-recurrent Cervical Cancer in Patients With Prior Pelvic Irradiation

“…However, there are several patients who cannot tolerate intense treatment or whose recurrent sites are beyond the pelvis, making it difficult to perform any salvage surgery. Systemic chemotherapy as an alternative treatment option is not generally considered to provide cure if used as a single therapy (20). Recent advents in chemotherapy proposed in vivo 33: 1659-1665 (2019) 1662 several agents such as docetaxel, TS-1, carboplatin, CPT-11, cyclophosphamide; however, the common agent in use remains cisplatin (15).…”

Microtubule Destabilizing Sulfonamides as an Alternative to Taxane-Based Chemotherapy

“…The most potent compounds (e.g., 29a, 30, 38, 42, 43, 44, and 45) showed IC50 values in the double-digit nanomolar range, less potent than paclitaxel and CA-4 but more than ABT-751. Substitutions on the trimethoxyphenyl ring resulted in inactive compounds (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24). Alkylations of the sulfonamide improved the potency, with methyl groups yielding the lowest IC50 values in most cases (e.g., 29a, 30, and 42).…”

“…First-line chemotherapy involves a platinum-taxane combination for ovarian cancer [ 12 , 13 , 14 ], preferably carboplatin/paclitaxel [ 15 ], and taxanes sequenced or combined with anthracyclines for advanced and metastatic breast cancer [ 16 , 17 , 18 , 19 ]. Furthermore, the combination of cisplatin and paclitaxel is considered a standard regimen in the palliative setting for patients with metastatic, recurrent, or persistent uterine cancer [ 9 , 20 , 21 , 22 ].…”

Simultaneous Metastasis from Cervical Cancer to the Kidney and Paraspinal Muscle: A Case Report

“…The risk of loco-regional failure, with or without accompanying distant recurrence in patients with locally advanced cervical cancer, can range between 30% and 70% [6]. The average time to recurrence ranges between 7 and 36 months after primary treatment [7].…”