HOUSTON, TexasIrinotecan (Camptosar) is active in platinum-refractory
cervical cancer and should be tested with cisplatin (Platinol) in randomized
trials, declared Claire F. Verschraegen, MD. The use of irinotecan might enable
clinicians in developing countries (where radiotherapy equipment is in short
supply) to downsize many cervical cancers to resectable size, Dr. Verschraegen
added. She is assistant professor in the Division of Cancer Medicine Section of
Gynecologic and Medical Therapeutics at the University of Texas M. D. Anderson
Cancer Center in Houston, Texas.
In summarizing studies on single-agent irinotecan, Dr. Verschraegen said,
"Taken together, there is a 4% complete remission (CR) rate. It is always
a little ray of hope to see some complete remissions in patients with recurrent
cervical cancer. Partial remissions were 14%, for a total response rate of 18%,
so this is a very acceptable drug as a single agent."
Her presentation mainly focused on squamous cell carcinoma and
adenocarcinoma. "Cervical cancer usually is very curable if detected
early, but once a patient is stage IIB or has nodes involved, the prognosis
worsens," she said.
Early Stage Disease
The usual treatment for early stage disease, up to Stage IB1, can be either
surgery or radiation therapy. Patients with Stage IIB2 or worse are treated
with concurrent chemoradiation. "In developing countries and in Europe
there are a number of ongoing studies of neoadjuvant chemotherapy prior to
surgery, but this is not a modality routinely used in the United States,"
Dr. Verschraegen said.
Locoregional recurrences can sometimes be salvaged by using radiation in
patients who had prior surgery, or surgery for patients with prior
radiotherapy. "If there is a central recurrence the patient may benefit
from an exenteration. This is a very tough surgery, but we have patients alive
30 and 40 years later," Dr. Verschraegen said.
Out-of-field recurrences following radiotherapy can sometimes be salvaged
with additional radiation with or without chemotherapy. For distant recurrences
other than an isolated metastasis, palliative chemotherapy is usually the only