Chemotherapy in advanced and recurrent cervical cancer. A review

Despite the success of cytologic techniques in the diagnosis of neoplastic changes in the epithelium of the uterine cervix and the resultant decrease in the incidence of cervical invasive malignancies, 4440 women in this country will die of cervical cancer in 1992. Although radiation therapy and surgery form the basis for treatment of disease limited to the pelvis, those who have advanced disease or recurrences after locoregional therapy depend on systemic treatment for any hope of disease control.

Patients with advanced disease (not curable by surgery and/or irradiation) and recurrent cervical cancer have received single and combination cytotoxic chemotherapeutic regimens.

Thirty-eight cytotoxic agents alone and in combination have been reported. Although none have produced a significant number of cures, several have shown moderate activity. Of particular interest, because of the relatively high response rates and carefully done trials, are cisplatin, ifosfamide, and dibromodulcitol with partial and complete response rates of 23%, 22%, and 22%, respectively. Currently, no combinations have been shown to be better than single agents.

No chemotherapy for advanced or recurrent carcinoma of the cervix is more effective than single-agent cisplatin. The major thrust of current and future investigation seeks to identify additional active agents and to develop combinations that offer greater patient benefit.