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Advanced and Relapsed Cervix Cancer ESGO Teaching Course Yerevan Armenia September 2010. Nick Reed Beatson Oncology Centre GLASGOW. Relapsed Cervix Cancer. Follow up of Cervix Cancer Careful Monitoring Clinical exam Symptoms Is there any role for routine imaging?
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Beatson Oncology Centre
Metastatic sites treated patients
Henriksen E: Am J Obst &Gyn 1949
Metastatic sites untreated patients
Henriksen E: Am J Obst & Gyn 1949
(Potter M : Cancer 1989)
Phase 2 studies
incl. 20% CR and median response of 26 mo
32% vs. 31% PFS and OS =
Bloss (JCO 2002 15: 165-171)
Alberts D ; JCO 1987: 5:1791-5
Vermorken JB et al, Int J Gyn Cancer 2000,10: 358-65
Wagenaar HC et al Eur J Cancer 37 1624-1628, 2001
BEMP 35% RR (CR 9%)
P 20% RR (CR 6%)
Outside clinical trials the use of Cisplatin alone is still the gold standard if chemotherapy is used for palliation.
The use of more aggressive regimes seems to bring additional toxicity.
GOG 169 and 179 bring fresh light.
Moore D, Proc ASCO 2001:20;201a
Patients Cisplatin 50 mg/m²
Stage IV B q 3 wks x 6
Cisplatin 50 mg/m² Paclitaxel 135 mg/m²/24h
Paclitaxel 135 mg/24 hrs
q 3 wks x 6
Cisplatin (C) vs Cisplatin plus Paclitaxel (CP)Phase III Study in SCCUC (GOG 169)
n=134 n=130 p-value
Response rate 19% 36% 0.002
CR rate 6% 15% < 0.05
Median PFS 2.8mo 4.8mo <0.001
Median survival 8.8mo 9.7mo ns
Neutropenia (G3+4) 31% 66.6%
Anemia (G3+4) 13% 27.9%
Quality of life no significant difference in scores
Cisplatin (C) vs Cisplatin plus Paclitaxel (CP)Phase III Study in SCCUC (GOG 169)Response rate according to previous platinum
C 2/40 ( 5%) 24/94 (26%)
C+P 10/31 (32%) 37/99 (37%)
Long H et al JCO 2005 : 23; 4626-33
Tiersten et al Gyn Onc 92,635-638: 2004
Zanetta, Mangioni et al
EGFR expression observed in 75-100 % of CC
Phase II study ZD1839 (500mg/d), no responses
Inhibition of angiogenesis a/o matrixmetalloproteinases. One complete response with TNP-470, an analogue of fumagillin, was seen in phase I.
Inhibition of COX-2 enhanced cytotoxicity in vitro of chemotherapy agents: potentiates tumor cell radiosensitivity in vivo
EGFR Tyrosine kinase inhibitors
Alone? Or Combined with radiation?
See H&N SCC data