Second line chemo for cervical cancer – pro
l.Lay Summary: Single agents are the best choice for 2nd line chemotherapy of cervical cancer.
Treatment is only palliative in patients with stage IVB disease, especially 2nd line, so quality of life and toxicity profiles must influence the choice of treatment. The only RCT to identify a chemotherapy regimen that gave these patients an overall survival advantage and that included quality of life measurements compared cisplatin with cisplatin plus topotecan. Progression free survival and overall survival favoured combination chemotherapy, but toxicity was more common, although it did not significantly reduce quality of life.
NCCN lists: 5fu and mitomycin as single agents, also docetaxel, ifosfomide, irinotecan, vinorelbine and epirubicin.
Treatment is only palliative in patients with stage IVB disease, especially 2nd line, so quality of life and toxicity profiles must influence the choice of treatment. The only RCT to identify a chemotherapy regimen that gave these patients an overall survival advantage and that included quality of life measurements compared cisplatin with cisplatin plus topotecan. Progression free survival and overall survival favoured combination chemotherapy, but toxicity was more common, although it did not significantly reduce quality of life.
NCCN lists: 5fu and mitomycin as single agents, also docetaxel, ifosfomide, irinotecan, vinorelbine and epirubicin. The proposed therapy is in a clinical trial that incldues an non-FDA approved drug, pralatrexate. I was not able to find this trial on the clinicaltrials.gov site.
Regarding Tarceva(erlotinib): Twenty-eight patients with squamous cell carcinoma were enrolled by Schilder. Twenty-five patients were evaluable. There were no objective responses with four (16%) achieving stable disease; only one patient had a PFS ≥ 6 months (4%). The one-sided 90% confidence interval (CI) for response was 0.0%–8.8%. The two-sided 90% CI for the proportion of patients surviving progression-free for at least 6 months is 0.2%–17.6%. Erlotinib was well tolerated with the most common drug-related adverse events being gastrointestinal toxicities, fatigue and rash.
Russell J. Schilder et al,A PHASE II TRIAL OF ERLOTINIB IN RECURRENT SQUAMOUS CELL CARCINOMA OF THE CERVIX: A GYNECOLOGIC ONCOLOGY GROUP STUDY Int J Gynecol Cancer. 2009 July; 19(5): 929–933.
Monk BJ, Huang HQ, Cella D, Long HJ III. Quality of life outcomes from a randomized phase III trial of cisplatin with or without topotecan in advanced carcinoma of the cervix: a gynecologic oncology group study. J Clin Oncol 2005;23:4617-25
nccn.org, cervical