Prospective validation of pooled clinical prognostic factors in patients with recurrent and advanced cervical cancer: A Gynecologic Oncology Group (GOG) study

American Journal of Obstetrics and Gynecology

2016

175

131

Despite availability of primary and secondary prevention measures, cervical cancer persists as one of the most common cancers among women around the world. While early stage disease can be cured with radical and even fertility-sparing surgery, patients with metastatic and recurrent cervical cancer have poor prognosis with historically limited treatment options and incurable disease. Significant advances in cervical cancer treatment have emerged as the result clinical trials seeking to determine the best therapy to prolong overall and progression-free survival. Most recently, trials involving angiogenesis blockade in addition to standard chemotherapy have demonstrated improved overall and progression free survival. This review serves to highlight pivotal trials in chemotherapy development for advanced, metastatic and recurrent cervical cancer including the paradigm-shifting work demonstrating increased overall survival with angiogenesis blockade.

Section: Bevacizumabmentioning

confidence: 99%

Section: Changing Paradigmsmentioning

confidence: 99%

Changing paradigms in the systemic treatment of advanced cervical cancer

Pfaendler

American Journal of Obstetrics and Gynecology

2016

175

131

“…Given the above findings, these prognosticators where evaluated prospectively as an exploratory end point in GOG 240 and the results were presented at the 2014 Society of Gynecologic Oncology Annual Meeting (FL, USA) [69]. Importantly, for the entire GOG 240 study population, the Moore criteria were prospectively validated.…”

Section: Predictors Of Response: Application Of the Moore Criteria Tomentioning

confidence: 99%

Development of bevacizumab in advanced cervical cancer: pharmacodynamic modeling, survival impact and toxicology

Eskander

2015

Future Oncol.

Historically, patients with metastatic, persistent or recurrent cervical cancer had limited therapeutic options. Despite several Phase II/III clinical trials, the combination of cisplatin and paclitaxel remained the most effective chemotherapeutic regimen. In 2014, publication of Gynecologic Oncology Group 240 represented the emergence of an alternate and effective therapeutic option. This prospective, randomized, Phase III clinical trial explored the impact of adding the antiangiogenic agent bevacizumab to two separate cytotoxic chemotherapy backbones. Importantly, the study met its primary end point, showing a survival advantage of approximately 4 months without detriment in quality of life. As such, a review of bevacizumab and its application in patients with advanced-stage cervical cancer is warranted.

“…In a pooled analysis of GOG 110, 169, and 179, patients in the high-risk category (four or five risk factors) were estimated to have an RR to platinum-based chemotherapy of only 13 %, and median PFS and OS of 2.8 and 5.5 months, respectively. GOG 240 not only prospectively validated the ‘Moore criteria’ but also revealed that the benefit of incorporating antiangiogenesis therapy was prolonged and possibly more robust in the high-risk group [29, 30]. Thus, antiangiogenesis therapy opens a window of opportunity in even the least responsive subset of patients.…”

Section: Beyond Targeted Therapymentioning

confidence: 99%

Pharmacologic Management of Advanced Cervical Cancer: Antiangiogenesis Therapy and Immunotherapeutic Considerations

Longoria

2015

Drugs

As a consequence of disparities in access to and utilization of preventative healthcare, the incidence and death rates from cervical cancer remain substantial in the face of indisputable evidence that screening saves lives. While disparities persist, there will be an urgent need for research into the treatment of advanced forms of this disease. In this review, we explore the evolution of the treatment of metastatic, recurrent, and persistent cervical cancer from cytotoxic agents to targeted therapy. We discuss why targeted therapies are unlikely to produce sustained responses alone but may be more successful in combination with immunotherapies. We also provide a rationale for the potential next phase in treatment of this challenging disease—combined therapy with antiangiogenic agents and immune checkpoint inhibitors. In doing so, we highlight recent paradigm shifts within cancer therapeutics, including the shift in focus from the tumor cell itself to the tumor microenvironment, and from stimulating the immune system to inhibiting the inhibitors of an adequate immune response.