Changing paradigms in the systemic treatment of advanced cervical cancer

Abstract

Despite availability of primary and secondary prevention measures, cervical cancer persists as one of the most common cancers among women around the world. Although early-stage disease can be cured with radical and even fertility-sparing surgery, patients with metastatic and recurrent cervical cancer have poor prognosis with historically limited treatment options and incurable disease. Significant advances in cervical cancer treatment have emerged as the result of clinical trials that have sought to determine the best therapy to prolong overall and progression-free survival. Most recently, trials that have involved angiogenesis blockade in addition to standard chemotherapy have demonstrated improved overall and progression-free survival. This review serves to highlight pivotal trials in chemotherapy development for advanced, metastatic, and recurrent cervical cancer that includes the paradigm-shifting work that demonstrates increased overall survival with angiogenesis blockade.

Keywords: antiangiogenesis; bevacizumab; cervical cancer.

Figure 1. Overall survival in GOG 240 according to chemotherapy regimen

Overall survival among patients assigned to cisplatin-paclitaxel (CP) chemotherapy with or without bevacizumab and those assigned to topotecan-paclitaxel (TP) chemotherapy with or without bevacizumab. (©Massachusetts Medical Society. Reprinted with permission from Tewari KS et al. N Engl J Med 2014;370(8):734–743.)

Figure 2. Changing Paradigms in Advanced, Metastatic and Recurrent Cervical Cancer

OS overall survival, PFS progression free survival, HRQoL health related quality of life, VEGF vascular endothelial growth factor. Shown are the paradigm changes described in the text.