Chemotherapy for stage IVB or recurrent cancer of the uterine cervix

Numerous drugs and drug combinations have been evaluated, largely in phase II trials, for the treatment of carcinoma of the uterine cervix. There clearly is a need for effective chemotherapy for this disease, but the results to date have unfortunately not met that need. Cisplatin is active but overrated. Drug combinations have not shown a consistent advantage and require careful study, with the initial focus on maximizing the complete response rate in women with no or minimal prior chemotherapy and with adequate sample size to have confidence about the results. The patient populations under treatment need to be carefully defined with respect to potential prognostic factors for response and survival, so that results will be more reproducible. The few large, randomized trials completed so far have failed to show a survival benefit with combination chemotherapy; in fact, there does not appear to have been a comparison of chemotherapy with best supportive care. Systemic therapy of cervical cancer remains experimental.