scholarly journals Molecular-guided therapy for disseminated cervical cancer: present and future

2020 ◽  
pp. 121-126
Author(s):  
A. А. Rumyantsev
Keyword(s):  
Cervical Cancer ◽  
Metastatic Cancer ◽  
Antiangiogenic Therapy ◽  
Phase Iii ◽  
Cervix Uteri ◽  
Term Survival ◽  
Recurrent Cervical Cancer ◽  
Number Of Patients ◽  
Incidence And Mortality ◽  
High Level

Сervical cancer is recognized as one of the leaders in mortality from gynecological oncological diseases. The incidence and mortality from cervical cancer over the past 10 years remained at a consistently high level. For a long time, the only treatment option for metastatic and/or recurrent cervical cancer was cytotoxic chemotherapy, but its results remained extremely unsatisfactory: the 5-year overall survival rate was about 12%. This article is devoted to a review of the current possibilities of targeted and immunotherapy of metastatic and/or recurrent cervical cancer. We reviewed the most recent studies in the field of the effectiveness of antiangiogenic therapy including a critical and detailed analysis of the results of the GOG-240 phase III study. The data of modern literature in the field of immunotherapy using PD-1 / PD-L1 signaling pathway inhibitors in metastatic cervical cancer has been studied. It was found that a significant number of patients (34-95%) showed increased expression of PD-L1 in the tumor tissue, and 3-6% of patients showed a high level of microsatellite instability (MSI) in the tumor, which reveals the possibility of immunotherapy for this disease. We also conducted a review of ongoing clinical studies on the use of targeted and immunotherapy of advanced cervical cancer and the prospects for changing the “landscape” of treatment for this disease were assessed. On the example of a clinical case of treatment of a real patient, the possibilities of modern targeted and immunotherapy of metastatic cancer of the cervix uteri were analyzed, which gave a possibility to ensure long-term survival for the patient with an initially poor prognosis.

Survival After Curative Pelvic Exenteration for Primary or Recurrent Cervical Cancer: A Retrospective Multicentric Study of 167 Patients

2014 ◽  
Vol 24 (5) ◽  
pp. 916-922 ◽  
Author(s):  
Vito Chiantera ◽  
Martina Rossi ◽  
Pierandrea De Iaco ◽  
Christardt Koehler ◽  
Simone Marnitz ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Overall Survival ◽  
Lymph Node ◽  
Pelvic Exenteration ◽  
Cell Cancer ◽  
Pelvic Lymph Node ◽  
Term Survival ◽  
Primary Tumors ◽  
Multicentric Study ◽  
Recurrent Cervical Cancer

ObjectiveEvaluate the survival of patients who underwent pelvic exenteration (PE) with curative intent for primary persistent or recurrent cervical cancer.MethodsWe retrospectively investigated 167 consecutive patients, referred to the gynecological oncology units of 4 centers in Germany or Italy, who underwent PE. Data regarding surgery, histology, and oncologic outcomes were collected and statistically evaluated. Survival was determined from the day of exenteration until last follow-up or death.ResultsThe median age was 51 years. Twenty-seven patients (16.2%) underwent PE owing to advanced primary tumors (group A), 34 patients (20.4%) underwent PE owing to persistent cancer after chemotherapy or chemoradiation (group B), and 106 patients (63.4%) underwent PE owing to recurrence (group C). The prevalent histologic type was squamous cell cancer. A complete tumor resection (R0), was achieved in 121 patients (72.5%). Forty-nine patients (29.3%) had pelvic lymph node metastases and 44 patients (26.3%) had pelvic sidewall involvement. Overall survival at the end of the study was 40.7%. The cumulative 5-year overall survival for the entire cohort was 38%. Resection margins, pelvic lymph node state, and sidewall involvement were independent prognostic factors in multivariate analysis.ConclusionPelvic exenteration is a valid therapeutic option for patients with locally advanced primary persistent or recurrent cervical cancer, with a long-term survival in 40% of the patients.

Incorporation of bevacizumab in the treatment of recurrent and metastatic cervical cancer: A phase III randomized trial of the Gynecologic Oncology Group.

2013 ◽  
Vol 31 (18_suppl) ◽  
pp. 3-3 ◽  
Author(s):  
Krishnansu Sujata Tewari ◽  
Michael Sill ◽  
Harry J. Long ◽  
Lois M. Ramondetta ◽  
Lisa Michelle Landrum ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Disease Progression ◽  
Interim Analysis ◽  
Gynecologic Oncology ◽  
Gynecologic Cancer ◽  
Single Agent ◽  
Phase Iii ◽  
Gynecologic Oncology Group ◽  
Recurrent Cervical Cancer ◽  
Anti Vegf

3 Background: Vascular endothelial growth factor (VEGF) promotes angiogenesis, a mediator of disease progression in cervical cancer. Bevacizumab (B), a humanized anti-VEGF monoclonal antibody, has shown single-agent activity in pretreated recurrent disease. We aimed to evaluate B in chemotherapy (CTX)-naive recurrent/persistent/metastatic cervical cancer. Methods: Using a 2x2 factorial design, patients were randomly assigned to CTX with or without B 15 mg/kg. The CTX regimens included cisplatin 50 mg/m2 plus paclitaxel 135-175 mg/m2 and topotecan 0.75 mg/m2 d1-3 plus paclitaxel 175 mg/m2d1. Cycles were repeated every 21 days until disease progression, unacceptable toxicity, or complete response. Overall survival (OS) was the primary endpoint with a reduction in the hazard of death by 30% using anti-VEGF therapy considered important (90% power, 1-sided alpha=2.5%). Final analysis was planned when 346 deaths were observed. Results: 452 patients were accrued from 4/6/09 to 1/3/12. The scheduled interim analysis occurred after 174 patients had died and showed that the topotecan-paclitaxel backbone was not superior to the cisplatin-paclitaxel backbone. A second interim analysis was conducted after 271 deaths. A total of 225 patients received CTX alone and 227 patients received CTX plus B. The randomized treatment groups were similar with regard to age, histology, performance status, previous platinum as a radiosensitizer, and recurrence, persistence, or advanced disease. The B-to-no-B hazard ratio (HR) of death was 0.71 (97.6% CI 0.54-0.95; 1-sided p=0.0035). Median survival was 17 m (CTX plus B) and 13.3 m (CTX alone). The RR were 48% (CTX plus B) and 36% (CTX alone) (p=0.0078). Treatment with B was associated with more grade 3-4 bleeding (5 vs 1%) thrombosis/embolism (9 vs 2%), and GI fistula (3 vs 0%). Conclusions: For the first time a targeted agent significantly improved OS in gynecologic cancer. The second interim analysis crossed the boundary for efficacy, warranting early release of this information. The nearly 4-month increase in median OS with the addition of B to CTX in women with recurrent cervical cancer is considered to be clinically significant. Clinical trial information: NCT00803062.

scholarly journals A single-arm study evaluating bevacizumab, cisplatin, and paclitaxel followed by single-agent bevacizumab in Japanese patients with advanced cervical cancer

2016 ◽  
Vol 47 (1) ◽  
pp. 39-46 ◽  
Author(s):  
Toru Sugiyama ◽  
Mika Mizuno ◽  
Yoichi Aoki ◽  
Manabu Sakurai ◽  
Tadaaki Nishikawa ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Adverse Events ◽  
Overall Response Rate ◽  
Response Rate ◽  
Japanese Patients ◽  
Primary Objective ◽  
Phase Iii ◽  
Advanced Cervical Cancer ◽  
Recurrent Cervical Cancer ◽  
Overall Response

Background Adding bevacizumab to chemotherapy for recurrent, persistent or metastatic cervical cancer significantly improved overall survival (primary endpoint), progression-free survival and overall response rate in the randomized Phase III GOG-0240 trial. However, data for bevacizumab-containing therapy are scarce in Japanese patients with advanced cervical cancer. Methods The primary objective of the single-arm multicenter Phase II JO29569 study was to evaluate the tolerability of paclitaxel (135 mg/m2 over 24 h or 175 mg/m2 over 3 h), cisplatin (50 mg/m2) and bevacizumab (15 mg/kg), administered every 3 weeks until disease progression or unacceptable toxicity in Japanese patients with stage IVB, persistent or recurrent cervical cancer. Results The seven treated patients received a median of nine (range 7–12) bevacizumab cycles and six (range 4–12) chemotherapy cycles. None of the predefined adverse events occurred during the tolerability evaluation period. The most common all-grade adverse events were alopecia, hypertension, decreased appetite, nausea and peripheral sensory neuropathy. There were no cases of fistula. The most common grade ≥3 adverse events were hypertension, neutrophil count decreased and neutropenia. Only one patient experienced febrile neutropenia. The overall response rate was 86% (95% confidence interval, 42–100%), including a complete response in one patient. At data cutoff, disease had progressed in one patient; bevacizumab therapy was ongoing in the remaining six. Conclusions According to the specified primary objective, a regimen of cisplatin, paclitaxel and bevacizumab was tolerable in Japanese patients and demonstrated encouraging activity in this small single-arm study. Further study is warranted to confirm the safety and effectiveness of bevacizumab in Japanese patients with cervical cancer.

scholarly journals Cervical Cancer- Care Delayed-Care Denied and Death Invited

2021 ◽  
Vol 4 (5) ◽  
Author(s):  
Navya MS
Keyword(s):  
Cervical Cancer ◽  
Rural Women ◽  
Gynecologic Oncology ◽  
Family Doctor ◽  
Cervix Uteri ◽  
International Agency ◽  
Care Seeking ◽  
Cancer Hospital ◽  
Incidence And Mortality ◽  
Local Doctor

With about 78 billion global population, in 2020, 19 million new cancers and nearly 1 million deaths due to all types estimated to occur. Cervical cancer does not figure in top 5 most common cancers in both sexes globally, but with 6.5% incidence it forms the fourth top among women worldwide. The cancer registry data across the country in India with simple average of the most recent local rates applied to 2020 population estimates a figure of 1324413 cases and 851678 in 2020 and cumulative prevalence around 2.7 million cases in last 5 years of all categories of cancers in India. Cervical cancers in India account for 10% of all cancers in both sexes and about 18% of cancers among women in India as per the international agency for Cancer Research. Nearly one-third of the global cervical cancer deaths occur in India. It is a preventable condition as it has a long precancerous stage amenable for screening and treating. Cervical cancer Cervix uteri is no 3 with about 123 907 cases (9.45) next only to Breast and Oral cancers with a 2.01 cumulative risk. Cervical cancer death risk as 60000 women die annually. While the incidence and mortality rates of cervical cancer in the world are 13.1/ and 6.9/ per lakh population, in India, it is estimated to be 14.7/and 9.2/ per lakh population. Resulting in about 96,922 new cervical cancer cases and 60,078 deaths ranking second among women cancers. The incidence varies within Indian population basically due to ggeographical and socio-economic disparities in screening practices and care seeking practices across the districts of India. Epidemiologically the symptoms are mild and mimic a venereal disease of low infectiousness and therefore delay in seeking care and reporting at a time when the prognosis is poor. The 5-year survival rate is around 76.0% for those aged ≤50 years with much poorer survival among cases with involvement lymph nodes. We present one such case of a 45 year’s old rural women reporting on 4th May 2021 with symptoms vaginal bleeding, back pain, urine leakage & pelvic pain since 2 months to a gynecologic oncology service at a cancer hospital & research center, Bangalore. She had the history of taking treatment for another 2 months earlier from a traditional healer with no progress. She had consulted a family doctor first who referred her to the Cancer hospital. After an evaluation for abnormal vagina bleeding, cervical biopsies that demonstrated invasive adenocarcinoma of the cervix (Stage IV B CA Cervix) the diagnosis was confirmed. Since it was in an advanced stage, a palliative management including radiation therapy for control of bleeding & pain, and systemic chemotherapy for disseminated disease was opted. After 22 days of treatment she got discharged along with medications prescribed Inj. Amikacin 100mg IV OD, Inj. Pantoprazole 40mg IV OD, DNS which was given by the local doctor. But there was no progress and finally she died on 17th June 2021 after 23 days of discharge. This case emphasizes the need for early care seeking behavior, regular screening for all women over 35-45 years and HPV vaccination for adolescent girls in India.

scholarly journals Cervical cancer (over)screening in Belgium and Switzerland: trends and social inequalities

2020 ◽  
Vol 30 (3) ◽  
pp. 552-557 ◽  
Author(s):  
Vincent De Prez ◽  
Vladimir Jolidon ◽  
Barbara Willems ◽  
Stéphane Cullati ◽  
Claudine Burton-Jeangros ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Pap Smear ◽  
Social Inequalities ◽  
Population Level ◽  
Health Interview Survey ◽  
Health Interview ◽  
Swiss Health ◽  
Incidence And Mortality ◽  
Interview Survey ◽  
High Level

Abstract Background Cervical cancer screening (CCS) by means of Pap smears has led to a decrease in cervical cancer incidence and mortality. In the absence of organized programmes, CCS is opportunistic in Belgium and Switzerland. This might result in a high level of CCS overuse, as screening practices do not conform to the recommended 3-yearly screening interval and the target age-ranges (Belgium: 25–64, Switzerland: 20–70). This study aimed to assess trends in CCS uptake and overuse in Belgium and Switzerland and their social determinants, in the light of reimbursement initiatives, which were implemented in both countries. Methods Data from five waves of the Belgian Health Interview Survey (1997–2013) (N=11 141) and Swiss Health Interview Survey (1992–2012) (N=32 696) were used. We performed Poisson regressions to estimate adjusted prevalence ratios (APR), controlled for socio-economic and socio-demographic characteristics and health status. CCS overuse was operationalized as screening more than once every 3 years and screening above recommended age-range. Results CCS uptake remained relatively stable over time, with a mean coverage of 70.9% in Belgium and 73.1% in Switzerland. Educational and income gradients were found in both countries. Concerning CCS overuse, women above screening-eligible age showed consistently high screening rates, but screening within the past year declined significantly in both countries, matching the temporal implementation of the reimbursement initiatives. Conclusions Although no increase in CCS coverage could be established, CCS has become more efficient in both countries as Pap smear overuse at the population level has declined after the implementation of reimbursement measures tackling CCS overuse.

scholarly journals Will the carboplatin-paclitaxel-bevacizumab combination become the preferred option as the first line in advanced cervical cancer? A small experience from a single oncologic Center

2017 ◽  
Vol 5 (1) ◽  
pp. 21-24
Author(s):  
Raquel Bratos Lorenzo ◽  
Luisa Sánchez Lorenzo ◽  
Antonio González-Martín
Keyword(s):  
Cervical Cancer ◽  
Metastatic Cancer ◽  
Treatment Options ◽  
Advanced Cervical Cancer ◽  
Recurrent Cervical Cancer ◽  
Curative Therapy ◽  
Screening Programs ◽  
Medical Need ◽  
Important Health ◽  
Future Therapy

Background: Despite the widespread introduction of screening programs, cervical cancer remains an important health problem, particularly in developing countries. Treatment options for patients with metastatic cancer and persistent or recurrent disease after curative therapy are limited and represent an unmet medical need. Patients and Methods: We report three clinical cases of metastatic cervical cancer in women treated with the combination of carboplatin, paclitaxel and bevacizumab. We also discuss current and future therapy for metastatic or recurrent cervical cancer, including ongoing investigations into the addition of bevacizumab to carboplatin/paclitaxel chemotherapy and the role of bevacizumab as maintenance therapy. Results and Conclusion: All three women received clinical benefit from the combination, including one complete and two partial responses. The tolerability of bevacizumab was excellent. Carboplatin/paclitaxel appears to be an acceptable and better tolerated alternative to cisplatin/paclitaxel in advanced or recurrent/persistent disease, and the carboplatin/paclitaxel/bevacizumab combination is under investigation for metastatic, recurrent or persistent cervical cancer in clinical trials such as the CECILIA trial (NCT02467907); the awaited results will add to the evidence for the use of this combination chemotherapy regimen in advanced cervical cancer.

Prospective phase I/II study of irradiation and concurrent chemotherapy for recurrent cervical cancer after radical hysterectomy

2004 ◽  
Vol 14 (5) ◽  
pp. 860-864
Author(s):  
P. W. Grigsby
Keyword(s):  
Cervical Cancer ◽  
Phase I ◽  
Late Toxicity ◽  
Concurrent Chemotherapy ◽  
Related Complication ◽  
Term Survival ◽  
Recurrent Cervical Cancer ◽  
Prospective Phase

The purpose of the present study was to evaluate the long-term toxicity and efficacy of irradiation and concurrent chemotherapy for patients with a pelvic recurrence of cervical cancer after a hysterectomy. This prospective phase I / II study was designed to administer irradiation and three cycles of concurrent chemotherapy with cisplatin and 5-FU to patients with recurrent cervical cancer confined to the pelvis. Initial therapy was a hysterectomy and none received prior pelvic irradiation. A total of 22 patients were entered into the study. Patients received irradiation and three cycles of concurrent cisplatin and 5-FU. The acute toxicity from chemotherapy and irradiation was grade 3 in 18% and grade 4 in 9%. No patient died from a treatment-related complication. Follow-up times ranged from 7.2 to 17.6 years. At last follow-up, 14 patients died of metastatic cervical cancer and eight were alive. The 10- and 15-year overall survivals were 35%. Long-term complications included leg edema, vesico-vaginal, and recto-vaginal fistulae. Pelvic abscesses developed in three of the four patients with a fistula. By logistic regression, the only significant factor for survival was total irradiation dose (P = 0.04). In conclusion, long-term survival with this treatment regimen is possible but is accompanied by significant late toxicity.

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