HOUSTON, TexasIrinotecan (Camptosar) is active in platinum-refractory cervical cancer and should be tested with cisplatin(Drug information on cisplatin) (Platinol) in randomized trials, declared Claire F. Verschraegen, MD. The use of irinotecan(Drug information on 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 option.