Role of Chemotherapy in Vulvar Cancers: Time to Rethink Standard of Care?

Abstract

The actual role of chemotherapy in vulvar cancer is undeniably a niche topic. The low incidence of the disease limits the feasibility of randomized trials. Decision making is thus oriented by clinical and pathological features, whose relevance is generally weighted against evidence from observational studies and clinical practice. The therapeutic management of vulvar cancer is increasingly codified and refined at an individual patient level. It is of note that the attitude towards evidence sharing and discussion within a multidisciplinary frame is progressively consolidating. Viable options included in the therapeutic armamentarium available for vulvar cancer patients are frequently an adaption from standards used for cervical or anal carcinoma. Chemotherapy is more frequently combined with radiotherapy as neo-/adjuvant or definitive treatment. Drugs commonly used are platinum derivative, 5-fluorouracil and mitomicin C, mostly in combination with radiotherapy for radiosensitization. Exclusive chemotherapy in the neo-/adjuvant setting comprises platinum-derivative, combined with bleomicin and methotrexate, 5-fluorouracil, ifosfamide or taxanes. In advanced disease, current regimens include cisplatin-based chemoradiation, with or without 5-fluorouracil, or doublets with platinum in combination with a taxane. Our work is also enriched by a concise excursus on the biologic pathways underlying vulvar cancer. Introductory hints are also provided on targeted agents, a rapidly evolving research field.

Squamous Cell Carcinoma of the Vulva: A Survival and Epidemiologic Study with Focus on Surgery and Radiotherapy

“…The role of adjuvant and neo-adjuvant therapies is believed to be mainly relevant in regional or distant disease. However, as Mazzotta et al suggested in their review, the level of evidence remains low and further research must be conducted to assess their real impact on survival and recurrence and to define the optimal tailored treatment strategy [26].…”

Perineural Invasion in Vulvar Squamous-Cell Carcinoma Is an Independent Risk Factor for Cancer-Specific Survival, but Not for Locoregional Recurrence: Results from a Single Tertiary Referral Center

“…To date, there are no agreed protocols for the adjuvant treatment of VC—especially regarding the role of systemic chemotherapy; in fact, the choice of treatment is based on the assessment of pathological features such as DOI, surgical margin status, and nodal involvement [ 32 ].…”

Neoadjuvant chemotherapy for patients with locally advanced vulvar cancer

“…The number of patients who underwent subsequent surgical treatment differed greatly in the published studies, between 20 and 100% of the patients. Complete pathological response was seen in 28.6–100% of the patients [3,19–32].…”

“…Again, chemotherapeutic regimens were highly heterogeneous. Chemotherapeutic agents used in these case series were bleomycin, methotrexaat, lomustine and cisplatin in various combinations [3,13].…”

“…Vulvar cancer accounts for 3–5% of all gynaecological malignancies [1,2] and has an incidence rate of two to three newly diagnosed patients per 100 000 women per year [3]. Prognosis strongly depends on the stage at diagnosis.…”