SECOND LINE SYSTEMIC TREATMENT OPTIONS FOR RECURRENT/ADVANCED CERVICAL CANCER- THE ROYAL MARSDEN EXPERIENCE
ΜπούσιοςΣ1, Okines A1, Gore M1, Kaye S1, Banerjee S1, Τάτση Κ2, Κωσταδήμα Λ3, Καφαντάρη Α3, Σεράι Ε3, Ζαρκαβέλης Γ3, Κολλάς Α3, Άσση Α3, Πετράκης Δ3, Πενθερουδάκης Γ3, Παυλίδης Ν3
1Gynaecology Unit, The Royal Marsden Hospital NHS Foundation Trust, London SW3 6JJ, United Kingdom
2 Γυναικολογική Κλινική Γενικού Νοσοκομείου Ιωαννίνων «Γ. Χατζηκώστα»
3Ογκολογική Κλινική Πανεπιστημιακού Νοσοκομείου Ιωαννίνων
Cervical cancer is the fourth most common cancer worldwide for women. Despite advances in screening and HPV vaccination, a significant number of women develop advanced disease. Palliative platinum-based chemotherapy (CT) is the standard first-line treatment for metastatic / recurrent cervical cancer.
Patients treated for cervical cancer between January 2004-June 2014 at the Royal Marsden were identified retrospectively using electronic patient records (n=508). Analyses were carried out for patients who received ≥1 line of CT for advanced / recurrent disease. The primary objective was to establish the type and number of lines of systemic treatment. Secondary endpoints included response rate (RR), median progression-free survival (PFS) and overall survival (OS).
75 patients (49 squamous, 15 adenocarcinoma, 11 other) received first-line systemic therapy for advanced / recurrent cervical cancer. The median PFS was 192 days. 53 patients (77.6%) were subsequently treated with second-line chemotherapy. 28/53 had relapsed >6 months after first-line platinum-based CT. Second-line regimens were as follows: weekly paclitaxel 15 (28.3%); platinum-based CT 12 (22.6%); novel targeted agents in clinical trials 12 (22.6%); docetaxel based clinical trials 8 (15.1%); topotecan 5 (9.4%); gemcitabine 1 (1.9%); erlotinib 1 (1.9%).
5 patients (9.4%) showed a radiological partial response, all of whom had received taxane-based combination regimens. A further 15 (28.3%) had stable disease (SD) at 4 months. The median PFS of second-line CT was 95 days and median OS 262 days. In the weekly paclitaxel-treated group, although no radiological responses were seen, 33.3% achieved SD at 4 months and the median PFS and OS were 95 and 198 days respectively.
Over 75% of patients treated with first-line CT for advanced / recurrent cervical cancer subsequently received further treatment. However, there remains no established standard of care for second-line systemic therapy for advanced disease setting. Patients should be considered for clinical trials, including novel targeted agents and potentially immunotherapy.