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49 regimens on this page 65 variants on this page

Chemoradiation

Cisplatin & RT

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RT: Radiation Therapy

Regimen #1

Study	Evidence	Comparator
Dueñas-González et al. 2011	Phase III	Cisplatin, Gemcitabine, RT

Chemoradiotherapy

Cisplatin (Platinol) 40 mg/m² IV over 60 minutes once per day on days 1, 8, 15, 22, 29, 36, 1 to 2 hours before radiation
Concurrent radiation therapy, 1.8 Gy x 28 fractions given 5 days per week, for an initial dose of 50.4 Gy

6-week course, followed by:

Brachytherapy

Brachytherapy with cesium-137, with 30 to 35 Gy delivered to point A

Regimen #2

Study	Evidence	Comparator
Lanciano et al. 2005 (GOG 165)	Phase III	Fluorouracil & RT

Chemoradiotherapy

Cisplatin (Platinol) 40 mg/m² (maximum of 70 mg per dose) IV once per day on days 1, 8, 15, 22, 29, 36, 4 hours before radiation
Concurrent radiation therapy, 1.8 Gy x 25 fractions, for an initial dose of 40.8 Gy

Brachytherapy

- EITHER Low-dose rate intracavitary brachytherapy of 40 Gy to point A given in 1 to 2 fractions
- OR High-dose rate intracavitary brachytherapy of 30 Gy to point A given in 5 fractions, starting week 4 of XRT
Parametrial boost of 5.4 to 9 Gy was administered to the involved parametrium after whole pelvic RT was complete

Regimen #3

Study	Evidence	Comparator
Rose et al. 1999 (GOG 120)	Phase III	Cisplatin, Fluorouracil, Hydroxyurea, RT Hydroxyurea & RT

Chemoradiotherapy

Cisplatin (Platinol) 40 mg/m² IV over 60 minutes once per day on days 1, 8, 15, 22, 29, 36, 4 hours before radiation
Concurrent radiation therapy
- Stage IIB patients received 1.7 Gy x 24 fractions, for an initial dose of 40.8 Gy
- Stage III or IVA disease received 1.7 Gy x 30 fractions, for an initial dose of 51 Gy

6-week course, followed in 1 to 3 weeks by:

Brachytherapy

Stage IIB patients received 40 Gy by intracavitary brachytherapy, for a total dose of 80.8 Gy to point A
Stage III or IVA disease received 30 Gy by intracavitary brachytherapy, for a total dose of 81 Gy to point A
- Patients that could not receive brachytherapy underwent additional external beam radiation therapy for a total dose of 61.2 Gy

References

Rose PG, Bundy BN, Watkins EB, Thigpen JT, Deppe G, Maiman MA, Clarke-Pearson DL, Insalaco S. Concurrent cisplatin-based radiotherapy and chemotherapy for locally advanced cervical cancer. N Engl J Med. 1999 Apr 15;340(15):1144-53. link to original article contains verified protocol PubMed
1. Update: Rose PG, Ali S, Watkins E, Thigpen JT, Deppe G, Clarke-Pearson DL, Insalaco S; Gynecologic Oncology Group. Long-term follow-up of a randomized trial comparing concurrent single agent cisplatin, cisplatin-based combination chemotherapy, or hydroxyurea during pelvic irradiation for locally advanced cervical cancer: a Gynecologic Oncology Group Study. J Clin Oncol. 2007 Jul 1;25(19):2804-10. Epub 2007 May 14. link to original article PubMed
Lanciano R, Calkins A, Bundy BN, Parham G, Lucci JA 3rd, Moore DH, Monk BJ, O'Connor DM. Randomized comparison of weekly cisplatin or protracted venous infusion of fluorouracil in combination with pelvic radiation in advanced cervix cancer: a gynecologic oncology group study. J Clin Oncol. 2005 Nov 20;23(33):8289-95. Epub 2005 Oct 17. link to original article contains verified protocol PubMed
Dueñas-González A, Zarbá JJ, Patel F, Alcedo JC, Beslija S, Casanova L, Pattaranutaporn P, Hameed S, Blair JM, Barraclough H, Orlando M. Phase III, open-label, randomized study comparing concurrent gemcitabine plus cisplatin and radiation followed by adjuvant gemcitabine and cisplatin versus concurrent cisplatin and radiation in patients with stage IIB to IVA carcinoma of the cervix. J Clin Oncol. 2011 May 1;29(13):1678-85. Epub 2011 Mar 28. link to original article contains verified protocol PubMed

Cisplatin & RT -> Hysterectomy

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RT: Radiation Therapy

Regimen

Study	Evidence	Comparator
Keys et al. 1999 (GOG 123)	Phase III	RT -> Hysterectomy

Chemoradiation

Cisplatin (Platinol) 40 mg/m² (maximum of 70 mg per dose) IV once per day on days 1, 8, 15, 22, 29, 36, 4 hours before radiation
Concurrent radiation therapy, 1.8 to 2 Gy given 5 days per week, for an initial dose of 45 Gy
- After external beam radiation, low-dose brachytherapy was administered, with 30 Gy to point A for a total dose of 75 Gy

All patients proceeded to adjuvant hysterectomy.

References

Keys HM, Bundy BN, Stehman FB, Muderspach LI, Chafe WE, Suggs CL 3rd, Walker JL, Gersell D. Cisplatin, radiation, and adjuvant hysterectomy compared with radiation and adjuvant hysterectomy for bulky stage IB cervical carcinoma. N Engl J Med. 1999 Apr 15;340(15):1154-61. link to original article contains verified protocol PubMed

Cisplatin, Fluorouracil, RT

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RT: Radiation Therapy

Regimen

Study	Evidence	Comparator
Whitney et al. 1999 (GOG 85/SWOG 8695)	Phase III	Hydroxyurea & RT
Peters et al. 2000 (GOG 109/SWOG-8797)	Phase III	Radiation therapy

Chemotherapy

Cisplatin (Platinol) 70 mg/m² IV over 2 hours once on day 1
Fluorouracil (5-FU) 1000 mg/m²/day IV continuous infusion over 96 hours on days 1 to 4 (total dose: 4000 mg/m²)

21-day cycle for 4 cycles

Concurrent radiation therapy

Concurrent radiation therapy, 1.7 Gy x 29 fractions given 5 days per week, for a total dose of 49.3 Gy
- Patients with positive high common iliac lymph nodes also received 1.5 Gy x 30 fractions given 5 days per week, for a total dose of 45 Gy

6-week course, started on cycle 1 day 1

References

Whitney CW, Sause W, Bundy BN, Malfetano JH, Hannigan EV, Fowler WC Jr, Clarke-Pearson DL, Liao SY. Randomized comparison of fluorouracil plus cisplatin versus hydroxyurea as an adjunct to radiation therapy in stage IIB-IVA carcinoma of the cervix with negative para-aortic lymph nodes: a Gynecologic Oncology Group and Southwest Oncology Group study. J Clin Oncol. 1999 May;17(5):1339-48. link to original article PubMed
Peters WA 3rd, Liu PY, Barrett RJ 2nd, Stock RJ, Monk BJ, Berek JS, Souhami L, Grigsby P, Gordon W Jr, Alberts DS. Concurrent chemotherapy and pelvic radiation therapy compared with pelvic radiation therapy alone as adjuvant therapy after radical surgery in high-risk early-stage cancer of the cervix. J Clin Oncol. 2000 Apr;18(8):1606-13. link to original article contains verified protocol PubMed

Cisplatin, Fluorouracil, Hydroxyurea, RT

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RT: Radiation Therapy

Regimen

Study	Evidence	Comparator
Rose et al. 1999 (GOG 120)	Phase III	Cisplatin & RT Hydroxyurea & RT

Chemoradiotherapy

Cisplatin (Platinol) 50 mg/m² IV once per day on days 1 & 29
Fluorouracil (5-FU) 1000 mg/m²/day IV continuous infusion over 96 hours on days 1 to 4, 29 to 32 (total dose: 8000 mg/m²)
Hydroxyurea (Hydrea) 2000 mg/m² PO two times per week, 2 hours before radiation on weeks 1 to 6
Concurrent radiation therapy
- Stage IIB patients received 1.7 Gy x 24 fractions, for an initial dose of 40.8 Gy
- Stage III or IVA disease received 1.7 Gy x 30 fractions, for an initial dose of 51 Gy

6-week course, followed in 1 to 3 weeks by:

Brachytherapy

Stage IIB patients received 40 Gy by intracavitary brachytherapy, for a total dose of 80.8 Gy to point A
Stage III or IVA disease received 30 Gy by intracavitary brachytherapy, for a total dose of 81 Gy to point A
- Patients that could not receive brachytherapy underwent additional external beam radiation therapy for a total dose of 61.2 Gy

References

Rose PG, Bundy BN, Watkins EB, Thigpen JT, Deppe G, Maiman MA, Clarke-Pearson DL, Insalaco S. Concurrent cisplatin-based radiotherapy and chemotherapy for locally advanced cervical cancer. N Engl J Med. 1999 Apr 15;340(15):1144-53. link to original article contains verified protocol PubMed
1. Update: Rose PG, Ali S, Watkins E, Thigpen JT, Deppe G, Clarke-Pearson DL, Insalaco S; Gynecologic Oncology Group. Long-term follow-up of a randomized trial comparing concurrent single agent cisplatin, cisplatin-based combination chemotherapy, or hydroxyurea during pelvic irradiation for locally advanced cervical cancer: a Gynecologic Oncology Group Study. J Clin Oncol. 2007 Jul 1;25(19):2804-10. Epub 2007 May 14. link to original article PubMed

Cisplatin, Gemcitabine, RT

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RT: Radiation Therapy

Regimen

Study	Evidence	Comparator
Dueñas-González et al. 2011	Phase III	Cisplatin & RT

Chemoradiotherapy

Cisplatin (Platinol) 40 mg/m² IV over 60 minutes once per day on days 1, 8, 15, 22, 29, 36, given first, 1 to 2 hours before radiation
Gemcitabine (Gemzar) 125 mg/m² IV over 30 to 60 minutes once per day on days 1, 8, 15, 22, 29, 36, given second, 1 to 2 hours before radiation
Concurrent radiation therapy, 1.8 Gy x 28 fractions given 5 days per week, for an initial dose of 50.4 Gy

6-week course, followed by:

Brachytherapy

Brachytherapy with cesium-137, with 30-35 Gy delivered to point A

Followed in 2 weeks by:

Chemotherapy

Cisplatin (Platinol) 50 mg/m² IV once on day 1
Gemcitabine (Gemzar) 1000 mg/m² IV once per day on days 1 & 8

21-day cycle for 2 cycles

References

Dueñas-González A, Zarbá JJ, Patel F, Alcedo JC, Beslija S, Casanova L, Pattaranutaporn P, Hameed S, Blair JM, Barraclough H, Orlando M. Phase III, open-label, randomized study comparing concurrent gemcitabine plus cisplatin and radiation followed by adjuvant gemcitabine and cisplatin versus concurrent cisplatin and radiation in patients with stage IIB to IVA carcinoma of the cervix. J Clin Oncol. 2011 May 1;29(13):1678-85. Epub 2011 Mar 28. link to original article contains verified protocol PubMed

Fluorouracil & RT

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RT: Radiation Therapy

Regimen

Study	Evidence	Comparator
Lanciano et al. 2005 (GOG 165)	Phase III	Cisplatin & RT

Chemoradiotherapy

Fluorouracil (5-FU) 225 mg/m²/day IV continuous infusion over five days per week x 6 weeks (total dose: 6750 mg/m²)
Concurrent radiation therapy, 1.8 Gy x 25 fractions, for an initial dose of 40.8 Gy
Brachytherapy involved:
- EITHER Low-dose rate intracavitary brachytherapy of 40 Gy to point A given in 1 to 2 fractions
- OR High-dose rate intracavitary brachytherapy of 30 Gy to point A given in 5 fractions, starting week 4 of XRT
Parametrial boost of 5.4 to 9 Gy was administered to the involved parametrium after whole pelvic RT was complete

References

Lanciano R, Calkins A, Bundy BN, Parham G, Lucci JA 3rd, Moore DH, Monk BJ, O'Connor DM. Randomized comparison of weekly cisplatin or protracted venous infusion of fluorouracil in combination with pelvic radiation in advanced cervix cancer: a gynecologic oncology group study. J Clin Oncol. 2005 Nov 20;23(33):8289-95. Epub 2005 Oct 17. link to original article contains verified protocol PubMed

Hydroxyurea & RT

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RT: Radiation Therapy

Regimen

Study	Evidence	Comparator
Hreshchyshyn et al. 1979 (GOG 04)	Phase III	Radiation therapy
Rose et al. 1999 (GOG 120)	Phase III	Cisplatin & RT Cisplatin, Fluorouracil, Hydroxyurea, RT
Whitney et al. 1999 (GOG 85/SWOG 8695)	Phase III	Cisplatin, Fluorouracil, RT

Chemoradiotherapy

Hydroxyurea (Hydrea) 2000 mg/m² PO two times per week, 2 hours before radiation on weeks 1 to 6
Concurrent radiation therapy as follows:
- Stage IIB patients received 1.7 Gy x 24 fractions, for an initial dose of 40.8 Gy
- Stage III or IVA disease received 1.7 Gy x 30 fractions, for an initial dose of 51 Gy

6-week course, followed in 1 to 3 weeks by:

Brachytherapy

Stage IIB patients received 40 Gy by intracavitary brachytherapy, for a total dose of 80.8 Gy to point A
Stage III or IVA disease received 30 Gy by intracavitary brachytherapy, for a total dose of 81 Gy to point A
- Patients that could not receive brachytherapy underwent additional external beam radiation therapy for a total dose of 61.2 Gy

References

Hreshchyshyn MM, Aron BS, Boronow RC, Franklin EW 3rd, Shingleton HM, Blessing JA. Hydroxyurea or placebo combined with radiation to treat stages IIIB and IV cervical cancer confined to the pelvis. Int J Radiat Oncol Biol Phys. 1979 Mar;5(3):317-22. link to article PubMed
Rose PG, Bundy BN, Watkins EB, Thigpen JT, Deppe G, Maiman MA, Clarke-Pearson DL, Insalaco S. Concurrent cisplatin-based radiotherapy and chemotherapy for locally advanced cervical cancer. N Engl J Med. 1999 Apr 15;340(15):1144-53. link to original article contains verified protocol PubMed
1. Update: Rose PG, Ali S, Watkins E, Thigpen JT, Deppe G, Clarke-Pearson DL, Insalaco S; Gynecologic Oncology Group. Long-term follow-up of a randomized trial comparing concurrent single agent cisplatin, cisplatin-based combination chemotherapy, or hydroxyurea during pelvic irradiation for locally advanced cervical cancer: a Gynecologic Oncology Group Study. J Clin Oncol. 2007 Jul 1;25(19):2804-10. Epub 2007 May 14. link to original article PubMed
Whitney CW, Sause W, Bundy BN, Malfetano JH, Hannigan EV, Fowler WC Jr, Clarke-Pearson DL, Liao SY. Randomized comparison of fluorouracil plus cisplatin versus hydroxyurea as an adjunct to radiation therapy in stage IIB-IVA carcinoma of the cervix with negative para-aortic lymph nodes: a Gynecologic Oncology Group and Southwest Oncology Group study. J Clin Oncol. 1999 May;17(5):1339-48. link to original article PubMed

Radiation therapy

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Regimen

Study	Evidence	Comparator
Peters et al. 2000 (GOG 109/SWOG-8797)	Phase III	Cisplatin, Fluorouracil, RT

Demonstrably inferior; here for reference purposes only.

References

Peters WA 3rd, Liu PY, Barrett RJ 2nd, Stock RJ, Monk BJ, Berek JS, Souhami L, Grigsby P, Gordon W Jr, Alberts DS. Concurrent chemotherapy and pelvic radiation therapy compared with pelvic radiation therapy alone as adjuvant therapy after radical surgery in high-risk early-stage cancer of the cervix. J Clin Oncol. 2000 Apr;18(8):1606-13. link to original article contains verified protocol PubMed

RT -> Hysterectomy

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RT: Radiation Therapy

Regimen

Study	Evidence	Comparator
Hreshchyshyn et al. 1979 (GOG 04)	Phase III	Hydroxyurea & RT
Keys et al. 1999 (GOG 123)	Phase III	Cisplatin & RT -> Hysterectomy

Demonstrably inferior; here for reference purposes only.

References

Hreshchyshyn MM, Aron BS, Boronow RC, Franklin EW 3rd, Shingleton HM, Blessing JA. Hydroxyurea or placebo combined with radiation to treat stages IIIB and IV cervical cancer confined to the pelvis. Int J Radiat Oncol Biol Phys. 1979 Mar;5(3):317-22. link to article PubMed
Keys HM, Bundy BN, Stehman FB, Muderspach LI, Chafe WE, Suggs CL 3rd, Walker JL, Gersell D. Cisplatin, radiation, and adjuvant hysterectomy compared with radiation and adjuvant hysterectomy for bulky stage IB cervical carcinoma. N Engl J Med. 1999 Apr 15;340(15):1154-61. link to original article contains verified protocol PubMed

Neoadjuvant chemotherapy

Cisplatin & Paclitaxel

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Regimen

Study	Evidence
Park et al. 2004	Phase II

Chemotherapy

Cisplatin (Platinol) 60 mg/m² IV over 2 hours once on day 1, given second
Paclitaxel (Taxol) 60 mg/m² IV over 3 hours once on day 1, given first

Supportive medications

Dexamethasone (Decadron) 20 mg PO 12 and 6 hours before Paclitaxel (Taxol)
Cimetidine (Tagamet) 300 mg IV 30 minutes prior to Paclitaxel (Taxol)
Diphenhydramine (Benadryl) 50 mg IV 30 minutes prior to Paclitaxel (Taxol)
Antiemetics before and 3 days after chemotherapy

10-day cycle for 3 cycles

Clinical response assessed after 3 cycles with pelvic examination and MRI.

References

Park DC, Kim JH, Lew YO, Kim DH, Namkoong SE. Phase II trial of neoadjuvant paclitaxel and cisplatin in uterine cervical cancer. Gynecol Oncol. 2004 Jan;92(1):59-63. link to original article contains verified protocol PubMed

Locally Advanced or Metastatic disease

Bevacizumab (Avastin)

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Regimen

Study	Evidence
Monk et al. 2009 (GOG 227-C)	Phase II

Chemotherapy

Bevacizumab (Avastin) 15 mg/kg IV once on day 1

21-day cycles

References

Monk BJ, Sill MW, Burger RA, Gray HJ, Buekers TE, Roman LD. Phase II trial of bevacizumab in the treatment of persistent or recurrent squamous cell carcinoma of the cervix: a gynecologic oncology group study. J Clin Oncol. 2009 Mar 1;27(7):1069-74. Epub 2009 Jan 12. link to original article contains verified protocol PubMed

Carboplatin (Paraplatin)

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Regimen

Study	Evidence
Weiss et al. 1990	Phase II

Chemotherapy

Carboplatin (Paraplatin) 400 mg/m² IV once on day 1

28-day cycles

References

Weiss GR, Green S, Hannigan EV, Boutselis JG, Surwit EA, Wallace DL, Alberts DS. A phase II trial of carboplatin for recurrent or metastatic squamous carcinoma of the uterine cervix: a Southwest Oncology Group study. Gynecol Oncol. 1990 Dec;39(3):332-6. link to original article PubMed

Carboplatin & Docetaxel

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Regimen

Study	Evidence
Nagao et al. 2005	Phase II

Chemotherapy

Carboplatin (Paraplatin) AUC 6 IV over 1 hour on day 1, given second
Docetaxel (Taxotere) 60 mg/m² IV over 1 hour on day 1, given first

Supportive medications

Dexamethasone (Decadron)
Ondansetron (Zofran) or Granisetron (Kytril) for antiemesis
Filgrastim (Neupogen) 5 mcg/kg once per day for patients with grade 4 neutropenia or febrile neutropenia

21-day cycles

References

Nagao S, Fujiwara K, Oda T, Ishikawa H, Koike H, Tanaka H, Kohno I. Combination chemotherapy of docetaxel and carboplatin in advanced or recurrent cervix cancer. A pilot study. Gynecol Oncol. 2005 Mar;96(3):805-9. link to original article contains verified protocol PubMed
Takekida S, Fujiwara K, Nagao S, Yamaguchi S, Yoshida N, Kitada F, Kigawa J, Terakawa N, Nishimura R. Phase II study of combination chemotherapy with docetaxel and carboplatin for locally advanced or recurrent cervical cancer. Int J Gynecol Cancer. 2010 Dec;20(9):1563-8. PubMed

Carboplatin & Paclitaxel

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Regimen

Study	Evidence
Pectasides et al. 2009	Phase II

Chemotherapy

Carboplatin (Paraplatin) AUC 5 IV over 1 hour once on day 1
Paclitaxel (Taxol) 175 mg/m² IV over 3 hours once on day 1

21-day cycle for 6 to 9 cycles

References

Pectasides D, Fountzilas G, Papaxoinis G, Pectasides E, Xiros N, Sykiotis C, Koumarianou A, Psyrri A, Panayiotides J, Economopoulos T. Carboplatin and paclitaxel in metastatic or recurrent cervical cancer. Int J Gynecol Cancer. 2009 May;19(4):777-81. link to original article contains protocol PubMed

Cisplatin (Platinol)

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Regimen

Study	Evidence	Comparator
Moore et al. 2004	Phase III	Cisplatin & Paclitaxel
Long et al. 2005	Phase III	Cisplatin & Topotecan

Chemotherapy

Cisplatin (Platinol) 50 mg/m² IV once on day 1

21-day cycles; if not responding, given for maximum of 6 cycles

References

Moore DH, Blessing JA, McQuellon RP, Thaler HT, Cella D, Benda J, Miller DS, Olt G, King S, Boggess JF, Rocereto TF. Phase III study of cisplatin with or without paclitaxel in stage IVB, recurrent, or persistent squamous cell carcinoma of the cervix: a gynecologic oncology group study. J Clin Oncol. 2004 Aug 1;22(15):3113-9. link to original article contains verified protocol PubMed
Long HJ 3rd, Bundy BN, Grendys EC Jr, Benda JA, McMeekin DS, Sorosky J, Miller DS, Eaton LA, Fiorica JV; Gynecologic Oncology Group Study. Randomized phase III trial of cisplatin with or without topotecan in carcinoma of the uterine cervix: a Gynecologic Oncology Group Study. J Clin Oncol. 2005 Jul 20;23(21):4626-33. Epub 2005 May 23. link to original article contains verified protocol PubMed

Cisplatin & Gemcitabine

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Regimen #1, 3-week cycles

Study	Evidence	Comparator
Monk et al. 2009	Phase III	Cisplatin & Paclitaxel Cisplatin & Topotecan Cisplatin & Vinorelbine

Chemotherapy

Cisplatin (Platinol) 50 mg/m² IV once on day 1
Gemcitabine (Gemzar) 1000 mg/m² IV once per day on days 1 & 8

21-day cycles

Regimen #2, 4-week cycles

Study	Evidence
Brewer et al. 2006	Phase II

Chemotherapy

Cisplatin (Platinol) 30 mg/m² IV once on day 1, given first
Gemcitabine (Gemzar) 800 mg/m² IV once per day on days 1 & 8, given second

28-day cycles

References

Brewer CA, Blessing JA, Nagourney RA, McMeekin DS, Lele S, Zweizig SL. Cisplatin plus gemcitabine in previously treated squamous cell carcinoma of the cervix: a phase II study of the Gynecologic Oncology Group. Gynecol Oncol. 2006 Feb;100(2):385-8. Epub 2005 Nov 4. link to original article contains verified protocol PubMed
Monk BJ, Sill MW, McMeekin DS, Cohn DE, Ramondetta LM, Boardman CH, Benda J, Cella D. Phase III trial of four cisplatin-containing doublet combinations in stage IVB, recurrent, or persistent cervical carcinoma: a Gynecologic Oncology Group study. J Clin Oncol. 2009 Oct 1;27(28):4649-55. Epub 2009 Aug 31. link to original article contains verified protocol PubMed

Cisplatin & Mitomycin

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Regimen

Study	Evidence
Wagenaar et al. 2001	Phase II

Note: The NCCN, Cervical Cancer version 1.2012, lists mitomycin monotherapy as a potential second-line therapy option, and cites the reference below, which describes a two-drug regimen. No primary reference for the monotherapy regimen could be found.

Chemotherapy

Cisplatin (Platinol) 50 mg/m² IV once on day 1, given second
Mitomycin (Mutamycin) 6 mg/m² IV push on day 1, given first

Supportive medications

1 liter NS over 1 hour and Furosemide (Lasix) before chemotherapy, and 1 liter NS over 1 hour after Cisplatin (Platinol)
Mannitol IV push prior to Cisplatin (Platinol)

28-day cycle for 9 cycles

References

Wagenaar HC, Pecorelli S, Mangioni C, van der Burg ME, Rotmensz N, Anastasopoulou A, Zola P, Veenhof CH, Lacave AJ, Neijt JP, van Oosterom AT, Einhorn N, Vermorken JB. Phase II study of mitomycin-C and cisplatin in disseminated, squamous cell carcinoma of the uterine cervix. A European Organization for Research and Treatment of Cancer (EORTC) Gynecological Cancer Group study. Eur J Cancer. 2001 Sep;37(13):1624-8. link to original article contains verified protocol PubMed

Cisplatin & Paclitaxel

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Regimen #1

Study	Evidence	Comparator
Tewari et al. 2014 (GOG 240)	Phase III	Cisplatin, Paclitaxel, Bevacizumab Topotecan & Paclitaxel Topotecan, Paclitaxel, Bevacizumab

Chemotherapy

Cisplatin (Platinol) 50 mg/m² IV once on day 1
Paclitaxel (Taxol) 135 or 175 mg/m² IV once on day 1

21-day cycles, given until progression of disease, unacceptable toxicity, or if the patient had a complete response

Regimen #2, CI paclitaxel

Study	Evidence	Comparator
Moore et al. 2004	Phase III	Cisplatin
Monk et al. 2009	Phase III	Cisplatin & Gemcitabine Cisplatin & Topotecan Cisplatin & Vinorelbine

Chemotherapy

Cisplatin (Platinol) 50 mg/m² IV once on day 2
Paclitaxel (Taxol) 135 mg/m² IV continuous infusion over 24 hours on day 1

Supportive medications

(varies depending on reference):
Dexamethasone (Decadron), Diphenhydramine (Benadryl), H2 receptor antagonist (such as Cimetidine (Tagamet) or Ranitidine (Zantac)), and prophylactic antiemetics.
"Adequate IV hydration and electrolyte replacement"

21-day cycles; if not responding, given for maximum of 6 cycles.

References

Moore DH, Blessing JA, McQuellon RP, Thaler HT, Cella D, Benda J, Miller DS, Olt G, King S, Boggess JF, Rocereto TF. Phase III study of cisplatin with or without paclitaxel in stage IVB, recurrent, or persistent squamous cell carcinoma of the cervix: a gynecologic oncology group study. J Clin Oncol. 2004 Aug 1;22(15):3113-9. link to original article contains verified protocol PubMed
Monk BJ, Sill MW, McMeekin DS, Cohn DE, Ramondetta LM, Boardman CH, Benda J, Cella D. Phase III trial of four cisplatin-containing doublet combinations in stage IVB, recurrent, or persistent cervical carcinoma: a Gynecologic Oncology Group study. J Clin Oncol. 2009 Oct 1;27(28):4649-55. Epub 2009 Aug 31. link to original article contains verified protocol PubMed
Tewari KS, Sill MW, Long HJ 3rd, Penson RT, Huang H, Ramondetta LM, Landrum LM, Oaknin A, Reid TJ, Leitao MM, Michael HE, Monk BJ. Improved survival with bevacizumab in advanced cervical cancer. N Engl J Med. 2014 Feb 20;370(8):734-43. link to original article link to supplementary appendix contains verified protocol PubMed

Cisplatin, Paclitaxel, Bevacizumab

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Regimen

Study	Evidence	Comparator
Tewari et al. 2014 (GOG 240)	Phase III	Cisplatin & Paclitaxel Topotecan & Paclitaxel Topotecan, Paclitaxel, Bevacizumab

Chemotherapy

Cisplatin (Platinol) 50 mg/m² IV once on day 1
Paclitaxel (Taxol) 135 or 175 mg/m² IV once on day 1
Bevacizumab (Avastin) 15 mg/kg IV once on day 1

21-day cycles; given until progression of disease, unacceptable toxicity, or if the patient had a complete response

References

Tewari KS, Sill MW, Long HJ 3rd, Penson RT, Huang H, Ramondetta LM, Landrum LM, Oaknin A, Reid TJ, Leitao MM, Michael HE, Monk BJ. Improved survival with bevacizumab in advanced cervical cancer. N Engl J Med. 2014 Feb 20;370(8):734-43. link to original article link to supplementary appendix contains verified protocol PubMed

Cisplatin & Topotecan

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Regimen

Study	Evidence	Comparator
Long et al. 2005	Phase III	Cisplatin
Monk et al. 2009	Phase III	Cisplatin & Gemcitabine Cisplatin & Paclitaxel Cisplatin & Vinorelbine

Chemotherapy

Cisplatin (Platinol) 50 mg/m² IV once on day 1, given second
Topotecan (Hycamtin) 0.75 mg/m² IV over 30 minutes once per day on days 1 to 3, given first

21-day cycles; if not responding, given for maximum of 6 cycles

References

Long HJ 3rd, Bundy BN, Grendys EC Jr, Benda JA, McMeekin DS, Sorosky J, Miller DS, Eaton LA, Fiorica JV; Gynecologic Oncology Group Study. Randomized phase III trial of cisplatin with or without topotecan in carcinoma of the uterine cervix: a Gynecologic Oncology Group Study. J Clin Oncol. 2005 Jul 20;23(21):4626-33. Epub 2005 May 23. link to original article contains verified protocol PubMed
Monk BJ, Sill MW, McMeekin DS, Cohn DE, Ramondetta LM, Boardman CH, Benda J, Cella D. Phase III trial of four cisplatin-containing doublet combinations in stage IVB, recurrent, or persistent cervical carcinoma: a Gynecologic Oncology Group study. J Clin Oncol. 2009 Oct 1;27(28):4649-55. Epub 2009 Aug 31. link to original article contains verified protocol PubMed

Cisplatin & Vinorelbine

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Regimen

Study	Evidence	Comparator
Monk et al. 2009	Phase III	Cisplatin & Gemcitabine Cisplatin & Paclitaxel Cisplatin & Topotecan

Chemotherapy

Cisplatin (Platinol) 50 mg/m² IV once on day 1
Vinorelbine (Navelbine) 30 mg/m² IV once per day on days 1 & 8

21-day cycles; if not responding, given for maximum of 6 cycles

References

Monk BJ, Sill MW, McMeekin DS, Cohn DE, Ramondetta LM, Boardman CH, Benda J, Cella D. Phase III trial of four cisplatin-containing doublet combinations in stage IVB, recurrent, or persistent cervical carcinoma: a Gynecologic Oncology Group study. J Clin Oncol. 2009 Oct 1;27(28):4649-55. Epub 2009 Aug 31. link to original article contains verified protocol PubMed

Docetaxel (Taxotere)

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Regimen #1, 4-week cycles

Study	Evidence
Garcia et al. 2008	Phase II

Chemotherapy

Docetaxel (Taxotere) 36 mg/m² IV over 1 hour once per day on days 1, 8, 15

Supportive medications

Dexamethasone (Decadron) 8 mg PO the evening before, morning of, and evening of each dose of docetaxel

28-day cycles

Regimen #2, 3-week cycles

Study	Evidence
Garcia et al. 2007	Phase II

Chemotherapy

Docetaxel (Taxotere) 100 mg/m² IV over 1 hour once on day 1

21-day cycles

References

Garcia AA, Blessing JA, Vaccarello L, Roman LD; Gynecologic Oncology Group Study. Phase II clinical trial of docetaxel in refractory squamous cell carcinoma of the cervix: a Gynecologic Oncology Group Study. Am J Clin Oncol. 2007 Aug;30(4):428-31. link to original article contains protocol PubMed
Garcia AA, Blessing JA, Nolte S, Mannel RS; Gynecologic Oncology Group. A phase II evaluation of weekly docetaxel in the treatment of recurrent or persistent endometrial carcinoma: a study by the Gynecologic Oncology Group. Gynecol Oncol. 2008 Oct;111(1):22-6. link to original article contains verified protocol PubMed

Fluorouracil & Folinic acid

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Regimen #1

Study	Evidence
Look et al. 1996	Phase II
Look et al. 1997	Phase II

Chemotherapy

Folinic acid (Leucovorin) 200 mg/m² IV bolus once per day on days 1 to 5, given first
Fluorouracil (5-FU) 370 mg/m² IV bolus over 5 minutes once per day on days 1 to 5, given second

28-day cycle for 2 cycles, then 35-day cycles given until progression of disease or unacceptable toxicity

Regimen #2

Study	Evidence
Look et al. 1992	Phase II

Chemotherapy

Folinic acid (Leucovorin) 20 mg/m² IV once per day on days 1 to 5, given first
Fluorouracil (5-FU) 425 mg/m² IV once per day on days 1 to 5, given second

28-day cycle for 2 cycles, then 35-day cycles given until progression of disease or unacceptable toxicity

References

Look KY, Blessing JA, Muss HB, Partridge EE, Malfetano JH. 5-fluorouracil and low-dose leucovorin in the treatment of recurrent squamous cell carcinoma of the cervix. A phase II trial of the Gynecologic Oncology Group. Am J Clin Oncol. 1992 Dec;15(6):497-9. PubMed
Look KY, Blessing JA, Gallup DG, Lentz SS. A phase II trial of 5-fluorouracil and high-dose leucovorin in patients with recurrent squamous cell carcinoma of the cervix: a Gynecologic Oncology Group study. Am J Clin Oncol. 1996 Oct;19(5):439-41. PubMed
Look KY, Blessing JA, Valea FA, McGehee R, Manetta A, Webster KD, Andersen WA. Phase II trial of 5-fluorouracil and high-dose leucovorin in recurrent adenocarcinoma of the cervix: a Gynecologic Oncology Group study. Gynecol Oncol. 1997 Dec;67(3):255-8. link to original article contains verified protocol PubMed

Gemcitabine (Gemzar)

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Regimen

Study	Evidence
Schilder et al. 2000 (GOG 127-K)	Phase II
Schilder et al. 2005	Phase II

Chemotherapy

Gemcitabine (Gemzar) 800 mg/m² IV over 30 minutes once per day on days 1, 8, 15

28-day cycles

References

Schilder RJ, Blessing JA, Morgan M, Mangan CE, Rader JS. Evaluation of gemcitabine in patients with squamous cell carcinoma of the cervix: a Phase II study of the gynecologic oncology group. Gynecol Oncol. 2000 Feb;76(2):204-7. link to original article contains verified protocol PubMed
Schilder RJ, Blessing J, Cohn DE. Evaluation of gemcitabine in previously treated patients with non-squamous cell carcinoma of the cervix: a phase II study of the Gynecologic Oncology Group. Gynecol Oncol. 2005 Jan;96(1):103-7. link to original article contains verified protocol PubMed

Ifosfamide (Ifex)

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Regimen

Study	Evidence
Coleman et al. 1986	Phase II
Sutton et al. 1993	Phase II
Sutton et al. 1993	Phase II

Chemotherapy

Ifosfamide (Ifex) 1500 mg/m² IV once per day on days 1 to 5
- Dosage for patients with previous pelvic radiation or other chemotherapy is 1200 mg/m²
- Dose could be increased by 300 mg/m² or decreased by 20% depending on toxicity

Supportive medications

Mesna (Mesnex) at 20% of ifosfamide dose (for example, 300 mg/m² for 1500 mg/m² dose of ifosfamide) IV given at 0, 4, and 8 hours after each dose of ifosfamide on days 1 to 5

21-day cycles

References

Coleman RE, Harper PG, Gallagher C, Osborne R, Rankin EM, Silverstone AC, Slevin ML, Souhami RL, Tobias JS, Trask CW et al. A phase II study of ifosfamide in advanced and relapsed carcinoma of the cervix. Cancer Chemother Pharmacol. 1986;18(3):280-3. PubMed
Sutton GP, Blessing JA, McGuire WP, Patton T, Look KY. Phase II trial of ifosfamide and mesna in patients with advanced or recurrent squamous carcinoma of the cervix who had never received chemotherapy: a Gynecologic Oncology Group study. Am J Obstet Gynecol. 1993 Mar;168(3 Pt 1):805-7. PubMed
Sutton GP, Blessing JA, DiSaia PJ, McGuire WP. Phase II study of ifosfamide and mesna in nonsquamous carcinoma of the cervix: a Gynecologic Oncology Group study. Gynecol Oncol. 1993 Apr;49(1):48-50. link to original article contains verified protocol PubMed

Irinotecan (Camptosar)

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Regimen

Study	Evidence
Verschraegen et al. 1997	Phase II

Chemotherapy

Irinotecan (Camptosar) 125 mg/m² IV over 90 minutes once per day on days 1, 8, 15, 22

Supportive medications

Diphenhydramine (Benadryl) 25 to 50 mg PO/IV every 6 hours as needed for diarrhea during irinotecan infusion
Atropine 1 mg IV every 6 hours as needed for diarrhea during irinotecan infusion
Loperamide (Lomotil) 4 mg PO as needed for each episode of delayed diarrhea between irinotecan infusions

42-day cycles

References

Verschraegen CF, Levy T, Kudelka AP, Llerena E, Ende K, Freedman RS, Edwards CL, Hord M, Steger M, Kaplan AL, Kieback D, Fishman A, Kavanagh JJ. Phase II study of irinotecan in prior chemotherapy-treated squamous cell carcinoma of the cervix. J Clin Oncol. 1997 Feb;15(2):625-31. link to original article contains verified protocol PubMed

Paclitaxel (Taxol)

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Regimen #1, CI paclitaxel

Study	Evidence
McGuire et al. 1996	Phase II
Curtin et al. 2001	Phase II

Chemotherapy

Paclitaxel (Taxol) 170 mg/m² IV continuous infusion over 24 hours on day 1
- Dosage for patients with previous pelvic radiation was 135 mg/m²
- Dose could be changed to 110 or 200 mg/m² depending on toxicity

Supportive medications

Dexamethasone (Decadron) 20 mg PO/IV 14 and 7 hours prior to paclitaxel
Diphenhydramine (Benadryl) 50 mg IV 30 minutes prior to paclitaxel
Ranitidine (Zantac) 50 mg IV 30 minutes prior to paclitaxel

21-day cycles

Regimen #2

Study	Evidence
Kudelka et al. 1996	Phase II

Chemotherapy

Paclitaxel (Taxol) 250 mg/m² IV over 3 hours on day 1
- Dose of Paclitaxel (Taxol) could be changed to 275, 225, or 200 mg/m² depending on toxicity

Supportive medications

Dexamethasone (Decadron) 20 mg PO 14 and 7 hours prior to paclitaxel
Cimetidine (Tagamet) 300 mg IV 60 minutes prior to paclitaxel
Diphenhydramine (Benadryl) 50 mg IV 60 minutes prior to paclitaxel
Filgrastim (Neupogen) 5 mcg/kg SC once per day starting on day 2, 24 hours after chemotherapy, given until day 19 or until ANC greater or equal to 10,000

21-day cycles

References

McGuire WP, Blessing JA, Moore D, Lentz SS, Photopulos G. Paclitaxel has moderate activity in squamous cervix cancer. A Gynecologic Oncology Group study. J Clin Oncol. 1996 Mar;14(3):792-5. link to original article contains verified protocol PubMed
Kudelka AP, Winn R, Edwards CL, Downey G, Greenberg H, Dakhil SR, Freedman RS, Loyer E, Rusinkiewicz J, Gacrama P, Fueger R, Kavanagh JJ. Activity of paclitaxel in advanced or recurrent squamous cell cancer of the cervix. Clin Cancer Res. 1996 Aug;2(8):1285-8. link to original article contains verified protocol PubMed content property of HemOnc.org
1. Update: Kudelka AP, Winn R, Edwards CL, Downey G, Greenberg H, Dakhil SR, Freedman RS, LoCoco S, Umbreit J, Delmore JE, Arbuck S, Loyer E, Gacrama P, Fueger R, Kavanagh JJ. An update of a phase II study of paclitaxel in advanced or recurrent squamous cell cancer of the cervix. Anticancer Drugs. 1997 Aug;8(7):657-61. PubMed
Curtin JP, Blessing JA, Webster KD, Rose PG, Mayer AR, Fowler WC Jr, Malfetano JH, Alvarez RD. Paclitaxel, an active agent in nonsquamous carcinomas of the uterine cervix: a Gynecologic Oncology Group Study. J Clin Oncol. 2001 Mar 1;19(5):1275-8. link to original article contains verified protocol PubMed

Pemetrexed (Alimta)

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Regimen

Study	Evidence
Miller et al. 2008	Phase II

Chemotherapy

Pemetrexed (Alimta) 900 mg/m² IV over 10 minutes once on day 1

Supportive medications

Folic acid 350 to 600 mcg PO once per day, starting 7 days before pemetrexed, to continue throughout therapy
Cyanocobalamin (Vitamin B12) 1000 mcg IM once 7 days before pemetrexed (then 1000 mcg to be given every 9 weeks thereafter)
Dexamethasone (Decadron) 4 mg PO BID the day before, the day of, and day after pemetrexed
No NSAIDs (nonsteroidal anti-inflammatory drugs) for 2 days before or after pemetrexed

21-day cycles

References

Miller DS, Blessing JA, Bodurka DC, Bonebrake AJ, Schorge JO; Gynecologic Oncology Group. Evaluation of pemetrexed (Alimta, LY231514) as second line chemotherapy in persistent or recurrent carcinoma of the cervix: a phase II study of the Gynecologic Oncology Group. Gynecol Oncol. 2008 Jul;110(1):65-70. Epub 2008 May 5. link to original article contains verified protocol PubMed

Topotecan (Hycamtin)

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Regimen #1, 4-week cycle

Study	Evidence
Muderspach et al. 2001	Phase II

Chemotherapy

Topotecan (Hycamtin) 1.5 mg/m² IV over 30 minutes once per day on days 1 to 5

28-day cycles

Regimen #2, 3-week cycle

Study	Evidence
Bookman et al. 2000 (GOG 127-F)	Phase II

Chemotherapy

Topotecan (Hycamtin) 1.5 mg/m² IV over 30 minutes once per day on days 1 to 5

21-day cycles

References

Bookman MA, Blessing JA, Hanjani P, Herzog TJ, Andersen WA. Topotecan in squamous cell carcinoma of the cervix: A Phase II study of the Gynecologic Oncology Group. Gynecol Oncol. 2000 Jun;77(3):446-9. link to original article contains verified protocol PubMed
Muderspach LI, Blessing JA, Levenback C, Moore JL Jr. A Phase II study of topotecan in patients with squamous cell carcinoma of the cervix: a gynecologic oncology group study. Gynecol Oncol. 2001 May;81(2):213-5. link to original article contains verified protocol PubMed

Topotecan & Paclitaxel

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Regimen

Study	Evidence	Comparator
Tewari et al. 2014 (GOG 240)	Phase III	Cisplatin & Paclitaxel Cisplatin, Paclitaxel, Bevacizumab Topotecan, Paclitaxel, Bevacizumab

In Tewari et al. 2014 (GOG 240), topotecan & paclitaxel +/- bevacizumab regimens were "associated with a significantly higher risk of progression" as compared to cisplatin & paclitaxel +/- bevacizumab regimens.

Chemotherapy

Topotecan (Hycamtin) 0.75 mg/m² IV once per day on days 1 to 3
Paclitaxel (Taxol) 175 mg/m² IV once on day 1

21-day cycles; given until progression of disease, unacceptable toxicity, or if the patient had a complete response

References

Tewari KS, Sill MW, Long HJ 3rd, Penson RT, Huang H, Ramondetta LM, Landrum LM, Oaknin A, Reid TJ, Leitao MM, Michael HE, Monk BJ. Improved survival with bevacizumab in advanced cervical cancer. N Engl J Med. 2014 Feb 20;370(8):734-43. link to original article link to supplementary appendix contains verified protocol PubMed

Topotecan, Paclitaxel, Bevacizumab

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Regimen

Study	Evidence	Comparator
Tewari et al. 2014 (GOG 240)	Phase III	Cisplatin & Paclitaxel Cisplatin, Paclitaxel, Bevacizumab Topotecan & Paclitaxel

In Tewari et al. 2014 (GOG 240), topotecan & paclitaxel +/- bevacizumab regimens were "associated with a significantly higher risk of progression" as compared to cisplatin & paclitaxel +/- bevacizumab regimens.

Chemotherapy

Topotecan (Hycamtin) 0.75 mg/m² IV once per day on days 1 to 3
Paclitaxel (Taxol) 175 mg/m² IV once on day 1
Bevacizumab (Avastin) 15 mg/kg IV once on day 1

21-day cycles; given until progression of disease, unacceptable toxicity, or if the patient had a complete response

References

Tewari KS, Sill MW, Long HJ 3rd, Penson RT, Huang H, Ramondetta LM, Landrum LM, Oaknin A, Reid TJ, Leitao MM, Michael HE, Monk BJ. Improved survival with bevacizumab in advanced cervical cancer. N Engl J Med. 2014 Feb 20;370(8):734-43. link to original article link to supplementary appendix contains verified protocol PubMed

Vinorelbine (Navelbine)

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Regimen #1, 2 weeks on, 1 week off dosing

Study	Evidence
Muggia et al. 2004	Phase II
Muggia et al. 2005	Phase II

Chemotherapy

Vinorelbine (Navelbine) 30 mg/m² IV once per day on days 1 & 8

21-day cycles

Regimen #2, weekly dosing

Study	Evidence
Morris et al. 1998	Phase II

Chemotherapy

Vinorelbine (Navelbine) 30 mg/m² IV once on day 1

7-day cycles

References

Morris M, Brader KR, Levenback C, Burke TW, Atkinson EN, Scott WR, Gershenson DM. Phase II study of vinorelbine in advanced and recurrent squamous cell carcinoma of the cervix. J Clin Oncol. 1998 Mar;16(3):1094-8. link to original article contains verified protocol PubMed
Muggia FM, Blessing JA, Method M, Miller DS, Johnson GA, Lee RB, Menzin A; Gynecologic Oncology Group study. Evaluation of vinorelbine in persistent or recurrent squamous cell carcinoma of the cervix: a Gynecologic Oncology Group study. Gynecol Oncol. 2004 Feb;92(2):639-43. link to original article contains verified protocol PubMed
Muggia FM, Blessing JA, Waggoner S, Berek JS, Monk BJ, Sorosky J, Pearl ML. Evaluation of vinorelbine in persistent or recurrent nonsquamous carcinoma of the cervix: a Gynecologic Oncology Group Study. Gynecol Oncol. 2005 Jan;96(1):108-11. link to original article contains verified protocol PubMed

@@ Line 19: / Line 19: @@
 RT: '''<u>R</u>'''adiation '''<u>T</u>'''herapy
-===Regimen #1 {{#subobject:63d249|Variant=1}}===
+===Regimen #1 {{#subobject:b23457|Variant=1}}===
 {| border="1" style="text-align:center;" !align="left"
 |'''Study'''
@@ Line 25: / Line 25: @@
 |'''Comparator'''
 |-
-|[http://www.nejm.org/doi/full/10.1056/NEJM199904153401502 Rose et al. 1999 (GOG 120)]
+|[http://jco.ascopubs.org/content/29/13/1678.long Dueñas-González et al. 2011]
 |<span
 style="background:#00CD00;
@@ Line 32: / Line 32: @@
 border-width:2px;
 border-style:solid;">Phase III</span>
-|[[Cervical_cancer#Cisplatin.2C_Fluorouracil.2C_Hydroxyurea.2C_RT|Cisplatin, Fluorouracil, Hydroxyurea, RT]]<br> [[Cervical_cancer#Hydroxyurea_.26_RT|Hydroxyurea & RT]]
+|[[Cervical_cancer#Cisplatin.2C_Gemcitabine.2C_RT|Cisplatin, Gemcitabine, RT]]
 |-
 |}
-Chemoradiation:
+====Chemoradiotherapy====
-*[[Cisplatin (Platinol)]] 40 mg/m2 IV over 60 minutes once per day on days 1, 8, 15, 22, 29, 36, 4 hours before radiation
+*[[Cisplatin (Platinol)]] 40 mg/m<sup>2</sup> IV over 60 minutes once per day on days 1, 8, 15, 22, 29, 36, '''1 to 2 hours before radiation'''
-*Concurrent radiation therapy
+*Concurrent radiation therapy, 1.8 Gy x 28 fractions given 5 days per week, for an initial dose of 50.4 Gy
-**Stage IIB patients received 1.7 Gy x 24 fractions, for an initial dose of 40.8 Gy
-**Stage III or IVA disease received 1.7 Gy x 30 fractions, for an initial dose of 51 Gy
-'''6-week course, then:'''
+'''6-week course, followed by:'''
-''Brachytherapy starts 1 to 3 weeks after external beam radiation:''
+====Brachytherapy====
+*Brachytherapy with cesium-137, with 30 to 35 Gy delivered to point A
-*Stage IIB patients received 40 Gy by intracavitary brachytherapy, for a total dose of 80.8 Gy to point A
+===Regimen #2 {{#subobject:ff6bdc|Variant=1}}===
-*Stage III or IVA disease received 30 Gy by intracavitary brachytherapy, for a total dose of 81 Gy to point A
-**Patients that could not receive brachytherapy underwent additional external beam radiation therapy for a total dose of 61.2 Gy
-===Regimen #2 {{#subobject:b23457|Variant=1}}===
 {| border="1" style="text-align:center;" !align="left"
 |'''Study'''
@@ Line 56: / Line 51: @@
 |'''Comparator'''
 |-
-|[http://jco.ascopubs.org/content/29/13/1678.long Dueñas-González et al. 2011]
+|[http://jco.ascopubs.org/content/23/33/8289.long Lanciano et al. 2005 (GOG 165)]
 |<span
 style="background:#00CD00;
@@ Line 63: / Line 58: @@
 border-width:2px;
 border-style:solid;">Phase III</span>
-|[[Cervical_cancer#Cisplatin.2C_Gemcitabine.2C_RT|Cisplatin, Gemcitabine, RT]]
+|[[Cervical_cancer#Fluorouracil_.26_RT|Fluorouracil & RT]]
 |-
 |}
-Chemoradiation:
+====Chemoradiotherapy====
-*[[Cisplatin (Platinol)]] 40 mg/m2 IV over 60 minutes once per day on days 1, 8, 15, 22, 29, 36, 1 to 2 hours before radiation
+*[[Cisplatin (Platinol)]] 40 mg/m<sup>2</sup> (maximum of 70 mg per dose) IV once per day on days 1, 8, 15, 22, 29, 36, '''4 hours before radiation'''
-*Concurrent radiation therapy, 1.8 Gy x 28 fractions given 5 days per week, for an initial dose of 50.4 Gy
+*Concurrent radiation therapy, 1.8 Gy x 25 fractions, for an initial dose of 40.8 Gy
-'''6-week course'''
+====Brachytherapy====
+**EITHER Low-dose rate intracavitary brachytherapy of 40 Gy to point A given in 1 to 2 fractions
-Brachytherapy:
+**OR High-dose rate intracavitary brachytherapy of 30 Gy to point A given in 5 fractions, starting week 4 of XRT
-*Brachytherapy with cesium-137, with 30-35 Gy delivered to point A
+*Parametrial boost of 5.4 to 9 Gy was administered to the involved parametrium after whole pelvic RT was complete
-===Regimen #3 {{#subobject:ff6bdc|Variant=1}}===
+===Regimen #3 {{#subobject:63d249|Variant=1}}===
 {| border="1" style="text-align:center;" !align="left"
 |'''Study'''
@@ Line 82: / Line 77: @@
 |'''Comparator'''
 |-
-|[http://jco.ascopubs.org/content/23/33/8289.long Lanciano et al. 2005 (GOG 165)]
+|[http://www.nejm.org/doi/full/10.1056/NEJM199904153401502 Rose et al. 1999 (GOG 120)]
 |<span
 style="background:#00CD00;
@@ Line 89: / Line 84: @@
 border-width:2px;
 border-style:solid;">Phase III</span>
-|[[Cervical_cancer#Fluorouracil_.26_RT|Fluorouracil & RT]]
+|[[Cervical_cancer#Cisplatin.2C_Fluorouracil.2C_Hydroxyurea.2C_RT|Cisplatin, Fluorouracil, Hydroxyurea, RT]]<br> [[Cervical_cancer#Hydroxyurea_.26_RT|Hydroxyurea & RT]]
 |-
 |}
+====Chemoradiotherapy====
+*[[Cisplatin (Platinol)]] 40 mg/m<sup>2</sup> IV over 60 minutes once per day on days 1, 8, 15, 22, 29, 36, 4 hours before radiation
+*Concurrent radiation therapy
+**Stage IIB patients received 1.7 Gy x 24 fractions, for an initial dose of 40.8 Gy
+**Stage III or IVA disease received 1.7 Gy x 30 fractions, for an initial dose of 51 Gy
-Chemoradiation:
+'''6-week course, followed in 1 to 3 weeks by:'''
-*[[Cisplatin (Platinol)]] 40 mg/m2 (maximum of 70 mg per dose) IV once per day on days 1, 8, 15, 22, 29, 36, '''4 hours before radiation'''
-*Concurrent radiation therapy, 1.8 Gy x 25 fractions, for an initial dose of 40.8 Gy
+====Brachytherapy====
-*Brachytherapy involved:
+*Stage IIB patients received 40 Gy by intracavitary brachytherapy, for a total dose of 80.8 Gy to point A
-**EITHER Low-dose rate intracavitary brachytherapy of 40 Gy to point A given in 1 to 2 fractions
+*Stage III or IVA disease received 30 Gy by intracavitary brachytherapy, for a total dose of 81 Gy to point A
-**OR High-dose rate intracavitary brachytherapy of 30 Gy to point A given in 5 fractions, starting week 4 of XRT
+**Patients that could not receive brachytherapy underwent additional external beam radiation therapy for a total dose of 61.2 Gy
-*Parametrial boost of 5.4-9 Gy was administered to the involved parametrium after whole pelvic RT was complete
 ===References===
@@ Line 133: / Line 132: @@
 ====Chemoradiation====
-*[[Cisplatin (Platinol)]] 40 mg/m2 (maximum of 70 mg per dose) IV once per day on days 1, 8, 15, 22, 29, 36, '''4 hours before radiation'''
+*[[Cisplatin (Platinol)]] 40 mg/m<sup>2</sup> (maximum of 70 mg per dose) IV once per day on days 1, 8, 15, 22, 29, 36, '''4 hours before radiation'''
 *Concurrent radiation therapy, 1.8 to 2 Gy given 5 days per week, for an initial dose of 45 Gy
 **After external beam radiation, low-dose brachytherapy was administered, with 30 Gy to point A for a total dose of 75 Gy
-*All patients proceeded to adjuvant hysterectomy
+''All patients proceeded to adjuvant hysterectomy.''
 ===References===
@@ Line 176: / Line 176: @@
 ====Chemotherapy====
-*[[Cisplatin (Platinol)]] 70 mg/m2 IV over 2 hours once on day 1
+*[[Cisplatin (Platinol)]] 70 mg/m<sup>2</sup> IV over 2 hours once on day 1
-*[[Fluorouracil (5-FU)]] 1000 mg/m2/day IV continuous infusion over 96 hours on days 1 to 4 (4000 mg/m2 total dose)
+*[[Fluorouracil (5-FU)]] 1000 mg/m<sup>2</sup>/day IV continuous infusion over 96 hours on days 1 to 4 (total dose: 4000 mg/m<sup>2</sup>)
-'''21-day cycle x 4 cycles'''
+'''21-day cycle for 4 cycles'''
 ====Concurrent radiation therapy====
@@ Line 215: / Line 215: @@
 |-
 |}
-Chemoradiation:
+====Chemoradiotherapy====
-*[[Cisplatin (Platinol)]] 50 mg/m2 IV once per day on days 1 & 29
+*[[Cisplatin (Platinol)]] 50 mg/m<sup>2</sup> IV once per day on days 1 & 29
-*[[Fluorouracil (5-FU)]] 1000 mg/m2/day IV continuous infusion over 96 hours (4000 mg/m2 total dose) on days 1 to 4, 29-32
+*[[Fluorouracil (5-FU)]] 1000 mg/m<sup>2</sup>/day IV continuous infusion over 96 hours on days 1 to 4, 29 to 32 (total dose: 8000 mg/m<sup>2</sup>)
-*[[Hydroxyurea (Hydrea)]] 2000 mg/m2 PO two times per week, 2 hours before radiation on weeks 1 to 6
+*[[Hydroxyurea (Hydrea)]] 2000 mg/m<sup>2</sup> PO two times per week, '''2 hours before radiation on weeks 1 to 6'''
 *Concurrent radiation therapy
 **Stage IIB patients received 1.7 Gy x 24 fractions, for an initial dose of 40.8 Gy
 **Stage III or IVA disease received 1.7 Gy x 30 fractions, for an initial dose of 51 Gy
-'''6-week course, then:'''
+'''6-week course, followed in 1 to 3 weeks by:'''
-''Brachytherapy starts 1 to 3 weeks after external beam radiation:''
+====Brachytherapy====
 *Stage IIB patients received 40 Gy by intracavitary brachytherapy, for a total dose of 80.8 Gy to point A
 *Stage III or IVA disease received 30 Gy by intracavitary brachytherapy, for a total dose of 81 Gy to point A
@@ Line 260: / Line 259: @@
 |}
-Chemoradiation:
+====Chemoradiotherapy====
-*[[Cisplatin (Platinol)]] 40 mg/m2 IV over 60 minutes once per day on days 1, 8, 15, 22, 29, 36, given first, 1 to 2 hours before radiation
+*[[Cisplatin (Platinol)]] 40 mg/m<sup>2</sup> IV over 60 minutes once per day on days 1, 8, 15, 22, 29, 36, '''given first, 1 to 2 hours before radiation'''
-*[[Gemcitabine (Gemzar)]] 125 mg/m2 IV over 30-60 minutes once per day on days 1, 8, 15, 22, 29, 36, given second, 1 to 2 hours before radiation
+*[[Gemcitabine (Gemzar)]] 125 mg/m<sup>2</sup> IV over 30 to 60 minutes once per day on days 1, 8, 15, 22, 29, 36, '''given second, 1 to 2 hours before radiation'''
 *Concurrent radiation therapy, 1.8 Gy x 28 fractions given 5 days per week, for an initial dose of 50.4 Gy
-'''6-week course'''
+'''6-week course, followed by:'''
-Brachytherapy:
+====Brachytherapy====
 *Brachytherapy with cesium-137, with 30-35 Gy delivered to point A
-Chemotherapy:
+'''Followed in 2 weeks by:'''
-*[[Cisplatin (Platinol)]] 50 mg/m2 IV on day 1
-*[[Gemcitabine (Gemzar)]] 1000 mg/m2 IV once per day on days 1 & 8
+====Chemotherapy====
+*[[Cisplatin (Platinol)]] 50 mg/m<sup>2</sup> IV once on day 1
+*[[Gemcitabine (Gemzar)]] 1000 mg/m<sup>2</sup> IV once per day on days 1 & 8
-'''21-day cycles x 2 cycles, to start 2 weeks after the end of brachytherapy'''
+'''21-day cycle for 2 cycles'''
 ===References===
@@ Line 304: / Line 305: @@
 |}
-Chemoradiation:
+====Chemoradiotherapy====
-*[[Fluorouracil (5-FU)]] 225 mg/m2/day IV continuous infusion over five days per week x 6 weeks
+*[[Fluorouracil (5-FU)]] 225 mg/m<sup>2</sup>/day IV continuous infusion over five days per week x 6 weeks (total dose: 6750 mg/m<sup>2</sup>)
 *Concurrent radiation therapy, 1.8 Gy x 25 fractions, for an initial dose of 40.8 Gy
 *Brachytherapy involved:
@@ Line 358: / Line 359: @@
 |}
-Chemoradiation:
+====Chemoradiotherapy====
-*[[Hydroxyurea (Hydrea)]] 2000 mg/m2 PO two times per week, 2 hours before radiation on weeks 1 to 6
+*[[Hydroxyurea (Hydrea)]] 2000 mg/m<sup>2</sup> PO two times per week, '''2 hours before radiation on weeks 1 to 6'''
-*Concurrent radiation therapy
+*Concurrent radiation therapy as follows:
 **Stage IIB patients received 1.7 Gy x 24 fractions, for an initial dose of 40.8 Gy
 **Stage III or IVA disease received 1.7 Gy x 30 fractions, for an initial dose of 51 Gy
-'''6-week course, then:'''
+'''6-week course, followed in 1 to 3 weeks by:'''
-''Brachytherapy starts 1 to 3 weeks after external beam radiation:''
+====Brachytherapy====
 *Stage IIB patients received 40 Gy by intracavitary brachytherapy, for a total dose of 80.8 Gy to point A
 *Stage III or IVA disease received 30 Gy by intracavitary brachytherapy, for a total dose of 81 Gy to point A
@@ Line 465: / Line 465: @@
 |-
 |}
+====Chemotherapy====
+*[[Cisplatin (Platinol)]] 60 mg/m<sup>2</sup> IV over 2 hours once on day 1, '''given second'''
+*[[Paclitaxel (Taxol)]] 60 mg/m<sup>2</sup> IV over 3 hours once on day 1, '''given first'''
-*[[Cisplatin (Platinol)]] 60 mg/m2 IV over 2 hours on day 1, '''given second'''
+====Supportive medications====
-*[[Paclitaxel (Taxol)]] 60 mg/m2 IV over 3 hours on day 1, '''given first'''
+*[[Dexamethasone (Decadron)]] 20 mg PO 12 and 6 hours before [[Paclitaxel (Taxol)]]
+*[[Cimetidine (Tagamet)]] 300 mg IV 30 minutes prior to [[Paclitaxel (Taxol)]]
-Supportive medications:
+*[[Diphenhydramine (Benadryl)]] 50 mg IV 30 minutes prior to [[Paclitaxel (Taxol)]]
-*[[Dexamethasone (Decadron)]] 20 mg PO 12 and 6 hours before paclitaxel
-*Cimetidine (Tagamet) 300 mg IV 30 minutes prior to paclitaxel
-*Diphenhydramine (Benadryl) 50 mg IV 30 minutes prior to paclitaxel
 *[[antiemesis|Antiemetics]] before and 3 days after chemotherapy
-'''10-day cycle x 3 cycles'''
+'''10-day cycle for 3 cycles'''
-*Clinical response assessed after 3 cycles with pelvic examination and MRI
+''Clinical response assessed after 3 cycles with pelvic examination and MRI.''
 ===References===
@@ Line 489: / Line 489: @@
 |}
 ===Regimen {{#subobject:67b93c|Variant=1}}===
-Level of Evidence:
+{| border="1" style="text-align:center;" !align="left"
-<span
+|'''Study'''
+|[[Levels_of_Evidence#Evidence|'''Evidence''']]
+|-
+|[http://jco.ascopubs.org/content/27/7/1069.long Monk et al. 2009 (GOG 227-C)]
+|<span
 style="background:#EEEE00;
 padding:3px 6px 3px 6px;
@@ Line 496: / Line 500: @@
 border-width:2px;
 border-style:solid;">Phase II</span>
+|-
-*[[Bevacizumab (Avastin)]] 15 mg/kg IV on day 1
+|}
+====Chemotherapy====
+*[[Bevacizumab (Avastin)]] 15 mg/kg IV once on day 1
 '''21-day cycles'''
 ===References===
+<!-- Presented in part at the 39th Annual Meeting of the Society of Gynecologic Oncologists, March 9-12, 2008, Tampa, FL. -->
 # Monk BJ, Sill MW, Burger RA, Gray HJ, Buekers TE, Roman LD. Phase II trial of bevacizumab in the treatment of persistent or recurrent squamous cell carcinoma of the cervix: a gynecologic oncology group study. J Clin Oncol. 2009 Mar 1;27(7):1069-74. Epub 2009 Jan 12. [http://jco.ascopubs.org/content/27/7/1069.long link to original article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/19139430 PubMed]
@@ Line 510: / Line 517: @@
 |}
 ===Regimen {{#subobject:fe1b36|Variant=1}}===
-Level of Evidence:
+{| border="1" style="text-align:center;" !align="left"
-<span
+|'''Study'''
+|[[Levels_of_Evidence#Evidence|'''Evidence''']]
+|-
+|[http://www.gynecologiconcology-online.net/article/0090-8258(90)90262-J/fulltext Weiss et al. 1990]
+|<span
 style="background:#EEEE00;
 padding:3px 6px 3px 6px;
@@ Line 517: / Line 528: @@
 border-width:2px;
 border-style:solid;">Phase II</span>
+|-
-*[[Carboplatin (Paraplatin)]] 400 mg/m2 IV on day 1
+|}
+====Chemotherapy====
+*[[Carboplatin (Paraplatin)]] 400 mg/m<sup>2</sup> IV once on day 1
 '''28-day cycles'''
 ===References===
-# Weiss GR, Green S, Hannigan EV, Boutselis JG, Surwit EA, Wallace DL, Alberts DS. A phase II trial of carboplatin for recurrent or metastatic squamous carcinoma of the uterine cervix: a Southwest Oncology Group study. Gynecol Oncol. 1990 Dec;39(3):332-6. [http://www.ncbi.nlm.nih.gov/pubmed/2258080 PubMed]
+# Weiss GR, Green S, Hannigan EV, Boutselis JG, Surwit EA, Wallace DL, Alberts DS. A phase II trial of carboplatin for recurrent or metastatic squamous carcinoma of the uterine cervix: a Southwest Oncology Group study. Gynecol Oncol. 1990 Dec;39(3):332-6. [http://www.gynecologiconcology-online.net/article/0090-8258(90)90262-J/fulltext link to original article] [http://www.ncbi.nlm.nih.gov/pubmed/2258080 PubMed]
 ==Carboplatin & Docetaxel {{#subobject:39c86d|Regimen=1}}==
@@ Line 531: / Line 544: @@
 |}
 ===Regimen {{#subobject:9fb5d5|Variant=1}}===
-Level of Evidence:
+{| border="1" style="text-align:center;" !align="left"
-<span
+|'''Study'''
+|[[Levels_of_Evidence#Evidence|'''Evidence''']]
+|-
+|[http://www.gynecologiconcology-online.net/article/S0090-8258(04)00975-8/abstract Nagao et al. 2005]
+|<span
 style="background:#EEEE00;
 padding:3px 6px 3px 6px;
@@ Line 538: / Line 555: @@
 border-width:2px;
 border-style:solid;">Phase II</span>
+|-
+|}
+====Chemotherapy====
+*[[Carboplatin (Paraplatin)]] AUC 6 IV over 1 hour on day 1, '''given second'''
+*[[Docetaxel (Taxotere)]] 60 mg/m<sup>2</sup> IV over 1 hour on day 1, '''given first'''
-*[[Carboplatin (Paraplatin)]] AUC 6 IV over 1 hour on day 1, given second
+====Supportive medications====
-*[[Docetaxel (Taxotere)]] 60 mg/m2 IV over 1 hour on day 1, given first
+*[[Dexamethasone (Decadron)]]
+*[[Ondansetron (Zofran)]] or [[Granisetron (Kytril)]] for [[antiemesis]]
+*[[Filgrastim (Neupogen)]] 5 mcg/kg once per day for patients with grade 4 neutropenia or febrile neutropenia
 '''21-day cycles'''
-Supportive medications:
-*[[Dexamethasone (Decadron)]]
-*Ondansetron or granisetron for [[antiemesis]]
-*[[Filgrastim (Neupogen)]] 5 mcg/kg daily for patients with grade 4 neutropenia or febrile neutropenia
 ===References===
-# Nagao S, Fujiwara K, Oda T, Ishikawa H, Koike H, Tanaka H, Kohno I. Combination chemotherapy of docetaxel and carboplatin in advanced or recurrent cervix cancer. A pilot study. Gynecol Oncol. 2005 Mar;96(3):805-9. [http://www.sciencedirect.com/science/article/pii/S0090825804009758 link to original article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/15721429 PubMed]
+# Nagao S, Fujiwara K, Oda T, Ishikawa H, Koike H, Tanaka H, Kohno I. Combination chemotherapy of docetaxel and carboplatin in advanced or recurrent cervix cancer. A pilot study. Gynecol Oncol. 2005 Mar;96(3):805-9. [http://www.gynecologiconcology-online.net/article/S0090-8258(04)00975-8/abstract link to original article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/15721429 PubMed]
 # Takekida S, Fujiwara K, Nagao S, Yamaguchi S, Yoshida N, Kitada F, Kigawa J, Terakawa N, Nishimura R. Phase II study of combination chemotherapy with docetaxel and carboplatin for locally advanced or recurrent cervical cancer. Int J Gynecol Cancer. 2010 Dec;20(9):1563-8. [http://www.ncbi.nlm.nih.gov/pubmed/21370599 PubMed]
@@ Line 559: / Line 578: @@
 |}
 ===Regimen {{#subobject:7668ec|Variant=1}}===
-Level of Evidence:
+{| border="1" style="text-align:center;" !align="left"
-<span
+|'''Study'''
+|[[Levels_of_Evidence#Evidence|'''Evidence''']]
+|-
+|[http://journals.lww.com/ijgc/pages/articleviewer.aspx?year=2009&issue=05000&article=00049&type=abstract Pectasides et al. 2009]
+|<span
 style="background:#EEEE00;
 padding:3px 6px 3px 6px;
@@ Line 566: / Line 589: @@
 border-width:2px;
 border-style:solid;">Phase II</span>
+|-
+|}
+====Chemotherapy====
+*[[Carboplatin (Paraplatin)]] AUC 5 IV over 1 hour once on day 1
+*[[Paclitaxel (Taxol)]] 175 mg/m<sup>2</sup> IV over 3 hours once on day 1
-*[[Carboplatin (Paraplatin)]] AUC 5 IV over 1 hour on day 1
+'''21-day cycle for 6 to 9 cycles'''
-*[[Paclitaxel (Taxol)]] 175 mg/m2 IV over 3 hours on day 1
-'''21-day cycles x 6 to 9 cycles'''
 ===References===
-# Moore KN, Herzog TJ, Lewin S, Giuntoli RL, Armstrong DK, Rocconi RP, Spannuth WA, Gold MA. A comparison of cisplatin/paclitaxel and carboplatin/paclitaxel in stage IVB, recurrent or persistent cervical cancer. Gynecol Oncol. 2007 May;105(2):299-303. Epub 2007 Feb 14. [http://www.sciencedirect.com/science/article/pii/S009082580600970X link to original article] [http://www.ncbi.nlm.nih.gov/pubmed/17303230 PubMed]
 # Pectasides D, Fountzilas G, Papaxoinis G, Pectasides E, Xiros N, Sykiotis C, Koumarianou A, Psyrri A, Panayiotides J, Economopoulos T. Carboplatin and paclitaxel in metastatic or recurrent cervical cancer. Int J Gynecol Cancer. 2009 May;19(4):777-81. [http://journals.lww.com/ijgc/pages/articleviewer.aspx?year=2009&issue=05000&article=00049&type=abstract link to original article] '''contains protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/19509587 PubMed]
@@ Line 606: / Line 630: @@
 |-
 |}
+====Chemotherapy====
-*[[Cisplatin (Platinol)]] 50 mg/m2 IV once on day 1
+*[[Cisplatin (Platinol)]] 50 mg/m<sup>2</sup> IV once on day 1
 '''21-day cycles; if not responding, given for maximum of 6 cycles'''
@@ Line 621: / Line 645: @@
 |}
-===Regimen #1 {{#subobject:2e2004|Variant=1}}===
+===Regimen #1, 3-week cycles {{#subobject:2e2004|Variant=1}}===
 {| border="1" style="text-align:center;" !align="left"
 |'''Study'''
@@ Line 637: / Line 661: @@
 |-
 |}
+====Chemotherapy====
-*[[Cisplatin (Platinol)]] 50 mg/m2 IV once on day 1
+*[[Cisplatin (Platinol)]] 50 mg/m<sup>2</sup> IV once on day 1
-*[[Gemcitabine (Gemzar)]] 1000 mg/m2 IV once per day on days 1 & 8
+*[[Gemcitabine (Gemzar)]] 1000 mg/m<sup>2</sup> IV once per day on days 1 & 8
 '''21-day cycles'''
-===Regimen #2 {{#subobject:777e52|Variant=1}}===
+===Regimen #2, 4-week cycles {{#subobject:777e52|Variant=1}}===
 {| border="1" style="text-align:center;" !align="left"
 |'''Study'''
@@ Line 657: / Line 681: @@
 |-
 |}
+====Chemotherapy====
-*[[Cisplatin (Platinol)]] 30 mg/m2 IV once on day 1, '''given first'''
+*[[Cisplatin (Platinol)]] 30 mg/m<sup>2</sup> IV once on day 1, '''given first'''
-*[[Gemcitabine (Gemzar)]] 800 mg/m2 IV once per day on days 1 & 8, '''given second'''
+*[[Gemcitabine (Gemzar)]] 800 mg/m<sup>2</sup> IV once per day on days 1 & 8, '''given second'''
 '''28-day cycles'''
@@ Line 673: / Line 697: @@
 |}
 ===Regimen {{#subobject:6e84ee|Variant=1}}===
-Level of Evidence:
+{| border="1" style="text-align:center;" !align="left"
-<span
+|'''Study'''
+|[[Levels_of_Evidence#Evidence|'''Evidence''']]
+|-
+|[http://www.ejcancer.info/article/S0959-8049%2801%2900178-2/abstract Wagenaar et al. 2001]
+|<span
 style="background:#EEEE00;
 padding:3px 6px 3px 6px;
@@ Line 680: / Line 708: @@
 border-width:2px;
 border-style:solid;">Phase II</span>
+|-
+|}
 ''Note: The NCCN, Cervical Cancer version 1.2012, lists mitomycin monotherapy as a potential second-line therapy option, and cites the reference below, which describes a two-drug regimen.  No primary reference for the monotherapy regimen could be found.''
-*[[Cisplatin (Platinol)]] 50 mg/m2 IV on day 1, given second
+====Chemotherapy====
-*[[Mitomycin (Mutamycin)]] 6 mg/m2 IV push on day 1, given first
+*[[Cisplatin (Platinol)]] 50 mg/m<sup>2</sup> IV once on day 1, '''given second'''
+*[[Mitomycin (Mutamycin)]] 6 mg/m<sup>2</sup> IV push on day 1, '''given first'''
-'''28-day cycles x 9 cycles'''
+====Supportive medications====
+*1 liter NS over 1 hour and [[Furosemide (Lasix)]] before chemotherapy, and 1 liter NS over 1 hour after [[Cisplatin (Platinol)]]
+*Mannitol IV push prior to [[Cisplatin (Platinol)]]
-Supportive hydration:
+'''28-day cycle for 9 cycles'''
-*1 liter NS over 1 hour and furosemide before chemotherapy, and 1 liter NS over 1 hour after cisplatin
-*Mannitol IV push prior to cisplatin
 ===References===
@@ Line 699: / Line 729: @@
 |[[#toc|back to top]]
 |}
-===Regimen #1 {{#subobject:bd6f7b|Variant=1}}===
+===Regimen #1 {{#subobject:PYV4|Variant=1}}===
 {| border="1" style="text-align:center;" !align="left"
 |'''Study'''
@@ Line 705: / Line 735: @@
 |'''Comparator'''
 |-
-|[http://jco.ascopubs.org/content/22/15/3113.long Moore et al. 2004]
+|[http://www.nejm.org/doi/full/10.1056/NEJMoa1309748#t=article Tewari et al. 2014 (GOG 240)]
 |<span
 style="background:#00CD00;
@@ Line 712: / Line 742: @@
 border-width:2px;
 border-style:solid;">Phase III</span>
-|[[Cervical_cancer#Cisplatin_.28Platinol.29|Cisplatin]]
+|[[#Cisplatin.2C_Paclitaxel.2C_Bevacizumab|Cisplatin, Paclitaxel, Bevacizumab]]<br> [[#Topotecan_.26_Paclitaxel|Topotecan & Paclitaxel]]<br>[[#Topotecan.2C_Paclitaxel.2C_Bevacizumab|Topotecan, Paclitaxel, Bevacizumab]]
-|-
-|[http://jco.ascopubs.org/content/27/28/4649.long Monk et al. 2009]
-|<span
-style="background:#00CD00;
-padding:3px 6px 3px 6px;
-border-color:black;
-border-width:2px;
-border-style:solid;">Phase III</span>
-|[[Cervical_cancer#Cisplatin_.26_Gemcitabine|Cisplatin & Gemcitabine]]<br> [[Cervical_cancer#Cisplatin_.26_Topotecan|Cisplatin & Topotecan]]<br> [[Cervical_cancer#Cisplatin_.26_Vinorelbine|Cisplatin & Vinorelbine]]
 |-
 |}
+====Chemotherapy====
+*[[Cisplatin (Platinol)]] 50 mg/m<sup>2</sup> IV once on day 1
+*[[Paclitaxel (Taxol)]] 135 or 175 mg/m<sup>2</sup> IV once on day 1
-*[[Cisplatin (Platinol)]] 50 mg/m2 IV once on day 2
+'''21-day cycles, given until progression of disease, unacceptable toxicity, or if the patient had a complete response'''
-*[[Paclitaxel (Taxol)]] 135 mg/m2 IV continuous infusion over 24 hours on day 1
-Supportive medications (varies depending on reference):
+===Regimen #2, CI paclitaxel {{#subobject:bd6f7b|Variant=1}}===
-*[[Dexamethasone (Decadron)]], [[Diphenhydramine (Benadryl)]], H2 receptor antagonist (such as [[Cimetidine (Tagamet)]] or [[Ranitidine (Zantac)]]), and prophylactic [[Antiemesis|antiemetics]].
-*"Adequate IV hydration and electrolyte replacement"
-'''21-day cycles; if not responding, given for maximum of 6 cycles.'''
-===Regimen #2 {{#subobject:PYV4|Variant=1}}===
 {| border="1" style="text-align:center;" !align="left"
 |'''Study'''
@@ Line 740: / Line 757: @@
 |'''Comparator'''
 |-
-|[http://www.nejm.org/doi/full/10.1056/NEJMoa1309748#t=article Tewari et al. 2014 (GOG 240)]
+|[http://jco.ascopubs.org/content/22/15/3113.long Moore et al. 2004]
+|<span
+style="background:#00CD00;
+padding:3px 6px 3px 6px;
+border-color:black;
+border-width:2px;
+border-style:solid;">Phase III</span>
+|[[Cervical_cancer#Cisplatin_.28Platinol.29|Cisplatin]]
+|-
+|[http://jco.ascopubs.org/content/27/28/4649.long Monk et al. 2009]
 |<span
 style="background:#00CD00;
@@ Line 747: / Line 773: @@
 border-width:2px;
 border-style:solid;">Phase III</span>
-|[[#Cisplatin.2C_Paclitaxel.2C_Bevacizumab|Cisplatin, Paclitaxel, Bevacizumab]]<br> [[#Topotecan_.26_Paclitaxel|Topotecan & Paclitaxel]]<br>[[#Topotecan.2C_Paclitaxel.2C_Bevacizumab|Topotecan, Paclitaxel, Bevacizumab]]
+|[[Cervical_cancer#Cisplatin_.26_Gemcitabine|Cisplatin & Gemcitabine]]<br> [[Cervical_cancer#Cisplatin_.26_Topotecan|Cisplatin & Topotecan]]<br> [[Cervical_cancer#Cisplatin_.26_Vinorelbine|Cisplatin & Vinorelbine]]
 |-
 |}
+====Chemotherapy====
+*[[Cisplatin (Platinol)]] 50 mg/m<sup>2</sup> IV once on day 2
+*[[Paclitaxel (Taxol)]] 135 mg/m<sup>2</sup> IV continuous infusion over 24 hours on day 1
-*[[Cisplatin (Platinol)]] 50 mg/m2 IV once on day 1
+====Supportive medications====
-*[[Paclitaxel (Taxol)]] 135 or 175 mg/m2 IV once on day 1
+*(varies depending on reference):
+*[[Dexamethasone (Decadron)]], [[Diphenhydramine (Benadryl)]], H2 receptor antagonist (such as [[Cimetidine (Tagamet)]] or [[Ranitidine (Zantac)]]), and prophylactic [[Antiemesis|antiemetics]].
+*"Adequate IV hydration and electrolyte replacement"
-'''21-day cycles, given until progression of disease, unacceptable toxicity, or if the patient had a complete response'''
+'''21-day cycles; if not responding, given for maximum of 6 cycles.'''
 ===References===
@@ Line 782: / Line 813: @@
 |-
 |}
+====Chemotherapy====
-*[[Cisplatin (Platinol)]] 50 mg/m2 IV once on day 1
+*[[Cisplatin (Platinol)]] 50 mg/m<sup>2</sup> IV once on day 1
-*[[Paclitaxel (Taxol)]] 135 or 175 mg/m2 IV once on day 1
+*[[Paclitaxel (Taxol)]] 135 or 175 mg/m<sup>2</sup> IV once on day 1
 *[[Bevacizumab (Avastin)]] 15 mg/kg IV once on day 1
@@ Line 822: / Line 853: @@
 |-
 |}
+====Chemotherapy====
-*[[Cisplatin (Platinol)]] 50 mg/m2 IV once on day 1, '''given second'''
+*[[Cisplatin (Platinol)]] 50 mg/m<sup>2</sup> IV once on day 1, '''given second'''
-*[[Topotecan (Hycamtin)]] 0.75 mg/m2 IV over 30 minutes once per day on days 1 to 3, '''given first'''
+*[[Topotecan (Hycamtin)]] 0.75 mg/m<sup>2</sup> IV over 30 minutes once per day on days 1 to 3, '''given first'''
 '''21-day cycles; if not responding, given for maximum of 6 cycles'''
@@ Line 853: / Line 884: @@
 |-
 |}
+====Chemotherapy====
-*[[Cisplatin (Platinol)]] 50 mg/m2 IV once on day 1
+*[[Cisplatin (Platinol)]] 50 mg/m<sup>2</sup> IV once on day 1
-*[[Vinorelbine (Navelbine)]] 30 mg/m2 IV once per day on days 1 & 8
+*[[Vinorelbine (Navelbine)]] 30 mg/m<sup>2</sup> IV once per day on days 1 & 8
 '''21-day cycles; if not responding, given for maximum of 6 cycles'''
@@ Line 867: / Line 898: @@
 |[[#toc|back to top]]
 |}
-===Regimen #1, Garcia et al. 2007 {{#subobject:744f01|Variant=1}}===
-Level of Evidence:
+===Regimen #1, 4-week cycles {{#subobject:328695|Variant=1}}===
-<span
+{| border="1" style="text-align:center;" !align="left"
+|'''Study'''
+|[[Levels_of_Evidence#Evidence|'''Evidence''']]
+|-
+|[http://www.gynecologiconcology-online.net/article/S0090-8258(08)00452-6/abstract Garcia et al. 2008]
+|<span
 style="background:#EEEE00;
 padding:3px 6px 3px 6px;
@@ Line 875: / Line 911: @@
 border-width:2px;
 border-style:solid;">Phase II</span>
+|-
+|}
+====Chemotherapy====
+*[[Docetaxel (Taxotere)]] 36 mg/m<sup>2</sup> IV over 1 hour once per day on days 1, 8, 15
-*[[Docetaxel (Taxotere)]] 100 mg/m2 IV over 1 hour on day 1
+====Supportive medications====
+*[[Dexamethasone (Decadron)]] 8 mg PO the evening before, morning of, and evening of each dose of docetaxel
-'''21-day cycles'''
+'''28-day cycles'''
-===Regimen #2, Garcia et al. 2008 {{#subobject:328695|Variant=1}}===
+===Regimen #2, 3-week cycles {{#subobject:744f01|Variant=1}}===
-Level of Evidence:
+{| border="1" style="text-align:center;" !align="left"
-<span
+|'''Study'''
+|[[Levels_of_Evidence#Evidence|'''Evidence''']]
+|-
+|[http://journals.lww.com/amjclinicaloncology/pages/articleviewer.aspx?year=2007&issue=08000&article=00014&type=abstract Garcia et al. 2007]
+|<span
 style="background:#EEEE00;
 padding:3px 6px 3px 6px;
@@ Line 888: / Line 933: @@
 border-width:2px;
 border-style:solid;">Phase II</span>
+|-
+|}
+====Chemotherapy====
+*[[Docetaxel (Taxotere)]] 100 mg/m<sup>2</sup> IV over 1 hour once on day 1
-*[[Docetaxel (Taxotere)]] 36 mg/m2 IV over 1 hour on days 1, 8, 15
+'''21-day cycles'''
-'''28-day cycles'''
-Supportive medications:
-*[[Dexamethasone (Decadron)]] 8 mg PO the evening before, morning of, and evening of each dose of docetaxel
 ===References===
@@ Line 905: / Line 949: @@
 |[[#toc|back to top]]
 |}
-===Regimen #1, Look et al. 1996 & Look et al. 1997 {{#subobject:937680|Variant=1}}===
+===Regimen #1 {{#subobject:937680|Variant=1}}===
-Level of Evidence:
+{| border="1" style="text-align:center;" !align="left"
-<span
+|'''Study'''
+|[[Levels_of_Evidence#Evidence|'''Evidence''']]
+|-
+|[http://www.ncbi.nlm.nih.gov/pubmed/8823469 Look et al. 1996]
+|<span
 style="background:#EEEE00;
 padding:3px 6px 3px 6px;
@@ Line 913: / Line 961: @@
 border-width:2px;
 border-style:solid;">Phase II</span>
+|-
+|[http://www.gynecologiconcology-online.net/article/S0090-8258(97)94886-1/abstract Look et al. 1997]
+|<span
+style="background:#EEEE00;
+padding:3px 6px 3px 6px;
+border-color:black;
+border-width:2px;
+border-style:solid;">Phase II</span>
+|-
+|}
+====Chemotherapy====
+*[[Folinic acid (Leucovorin)]] 200 mg/m<sup>2</sup> IV bolus once per day on days 1 to 5, '''given first'''
+*[[Fluorouracil (5-FU)]] 370 mg/m<sup>2</sup> IV bolus over 5 minutes once per day on days 1 to 5, '''given second'''
-*[[Folinic acid (Leucovorin)]] 200 mg/m2 IV bolus on days 1 to 5, given first
+'''28-day cycle for 2 cycles, then 35-day cycles given until progression of disease or unacceptable toxicity'''
-*[[Fluorouracil (5-FU)]] 370 mg/m2 IV bolus over 5 minutes once per day on days 1 to 5, given second
-'''28-day cycles x 2 cycles, then 35-day cycles given until progression of disease or unacceptable toxicity'''
+===Regimen #2 {{#subobject:c76c92|Variant=1}}===
+{| border="1" style="text-align:center;" !align="left"
-===Regimen #2, Look et al. 1992 {{#subobject:c76c92|Variant=1}}===
+|'''Study'''
-Level of Evidence:
+|[[Levels_of_Evidence#Evidence|'''Evidence''']]
-<span
+|-
+|[http://www.ncbi.nlm.nih.gov/pubmed/1449112 Look et al. 1992]
+|<span
 style="background:#EEEE00;
 padding:3px 6px 3px 6px;
@@ Line 927: / Line 989: @@
 border-width:2px;
 border-style:solid;">Phase II</span>
+|-
+|}
+====Chemotherapy====
+*[[Folinic acid (Leucovorin)]] 20 mg/m<sup>2</sup> IV once per day on days 1 to 5, '''given first'''
+*[[Fluorouracil (5-FU)]] 425 mg/m<sup>2</sup> IV once per day on days 1 to 5, '''given second'''
-*[[Folinic acid (Leucovorin)]] 20 mg/m2 IV once per day on days 1 to 5, given first
+'''28-day cycle for 2 cycles, then 35-day cycles given until progression of disease or unacceptable toxicity'''
-*[[Fluorouracil (5-FU)]] 425 mg/m2 IV once per day on days 1 to 5, given second
-'''28-day cycles x 2 cycles, then 35-day cycles given until progression of disease or unacceptable toxicity'''
 ===References===
 # Look KY, Blessing JA, Muss HB, Partridge EE, Malfetano JH. 5-fluorouracil and low-dose leucovorin in the treatment of recurrent squamous cell carcinoma of the cervix. A phase II trial of the Gynecologic Oncology Group. Am J Clin Oncol. 1992 Dec;15(6):497-9. [http://www.ncbi.nlm.nih.gov/pubmed/1449112 PubMed]
 # Look KY, Blessing JA, Gallup DG, Lentz SS. A phase II trial of 5-fluorouracil and high-dose leucovorin in patients with recurrent squamous cell carcinoma of the cervix: a Gynecologic Oncology Group study. Am J Clin Oncol. 1996 Oct;19(5):439-41. [http://www.ncbi.nlm.nih.gov/pubmed/8823469 PubMed]
-# Look KY, Blessing JA, Valea FA, McGehee R, Manetta A, Webster KD, Andersen WA. Phase II trial of 5-fluorouracil and high-dose leucovorin in recurrent adenocarcinoma of the cervix: a Gynecologic Oncology Group study. Gynecol Oncol. 1997 Dec;67(3):255-8. [http://www.sciencedirect.com/science/article/pii/S0090825897948861 link to original article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/9441772 PubMed]
+# Look KY, Blessing JA, Valea FA, McGehee R, Manetta A, Webster KD, Andersen WA. Phase II trial of 5-fluorouracil and high-dose leucovorin in recurrent adenocarcinoma of the cervix: a Gynecologic Oncology Group study. Gynecol Oncol. 1997 Dec;67(3):255-8. [http://www.gynecologiconcology-online.net/article/S0090-8258(97)94886-1/abstract link to original article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/9441772 PubMed]
 ==Gemcitabine (Gemzar) {{#subobject:313d78|Regimen=1}}==
@@ Line 944: / Line 1,008: @@
 |}
 ===Regimen {{#subobject:9f6038|Variant=1}}===
-Level of Evidence:
+{| border="1" style="text-align:center;" !align="left"
-<span
+|'''Study'''
+|[[Levels_of_Evidence#Evidence|'''Evidence''']]
+|-
+|[http://www.gynecologiconcology-online.net/article/S0090-8258(99)95671-8/abstract Schilder et al. 2000 (GOG 127-K)]
+|<span
 style="background:#EEEE00;
 padding:3px 6px 3px 6px;
@@ Line 951: / Line 1,019: @@
 border-width:2px;
 border-style:solid;">Phase II</span>
+|-
-*[[Gemcitabine (Gemzar)]] 800 mg/m2 IV over 30 minutes once per day on days 1, 8, 15
+|[http://www.gynecologiconcology-online.net/article/S0090-8258(04)00773-5/abstract Schilder et al. 2005]
+|<span
+style="background:#EEEE00;
+padding:3px 6px 3px 6px;
+border-color:black;
+border-width:2px;
+border-style:solid;">Phase II</span>
+|-
+|}
+====Chemotherapy====
+*[[Gemcitabine (Gemzar)]] 800 mg/m<sup>2</sup> IV over 30 minutes once per day on days 1, 8, 15
 '''28-day cycles'''
 ===References===
-# Schilder RJ, Blessing JA, Morgan M, Mangan CE, Rader JS. Evaluation of gemcitabine in patients with squamous cell carcinoma of the cervix: a Phase II study of the gynecologic oncology group. Gynecol Oncol. 2000 Feb;76(2):204-7. [http://www.sciencedirect.com/science/article/pii/S0090825899956718 link to original article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/10637071 PubMed]
+# Schilder RJ, Blessing JA, Morgan M, Mangan CE, Rader JS. Evaluation of gemcitabine in patients with squamous cell carcinoma of the cervix: a Phase II study of the gynecologic oncology group. Gynecol Oncol. 2000 Feb;76(2):204-7. [http://www.gynecologiconcology-online.net/article/S0090-8258(99)95671-8/abstract link to original article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/10637071 PubMed]
-# Schilder RJ, Blessing J, Cohn DE. Evaluation of gemcitabine in previously treated patients with non-squamous cell carcinoma of the cervix: a phase II study of the Gynecologic Oncology Group. Gynecol Oncol. 2005 Jan;96(1):103-7. [http://www.sciencedirect.com/science/article/pii/S0090825804007735 link to original article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/15589587 PubMed]
+# Schilder RJ, Blessing J, Cohn DE. Evaluation of gemcitabine in previously treated patients with non-squamous cell carcinoma of the cervix: a phase II study of the Gynecologic Oncology Group. Gynecol Oncol. 2005 Jan;96(1):103-7. [http://www.gynecologiconcology-online.net/article/S0090-8258(04)00773-5/abstract link to original article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/15589587 PubMed]
 ==Ifosfamide (Ifex) {{#subobject:1d18ed|Regimen=1}}==
@@ Line 966: / Line 1,044: @@
 |}
 ===Regimen {{#subobject:962339|Variant=1}}===
-Level of Evidence:
+{| border="1" style="text-align:center;" !align="left"
-<span
+|'''Study'''
+|[[Levels_of_Evidence#Evidence|'''Evidence''']]
+|-
+|[http://www.ncbi.nlm.nih.gov/pubmed/3802384 Coleman et al. 1986]
+|<span
 style="background:#EEEE00;
 padding:3px 6px 3px 6px;
@@ Line 973: / Line 1,055: @@
 border-width:2px;
 border-style:solid;">Phase II</span>
+|-
+|[http://www.ncbi.nlm.nih.gov/pubmed/8456884 Sutton et al. 1993]
+|<span
+style="background:#EEEE00;
+padding:3px 6px 3px 6px;
+border-color:black;
+border-width:2px;
+border-style:solid;">Phase II</span>
+|-
+|[http://www.gynecologiconcology-online.net/article/S0090-8258(83)71084-X/abstract Sutton et al. 1993]
+|<span
+style="background:#EEEE00;
+padding:3px 6px 3px 6px;
+border-color:black;
+border-width:2px;
+border-style:solid;">Phase II</span>
+|-
+|}
+====Chemotherapy====
+*[[Ifosfamide (Ifex)]] 1500 mg/m<sup>2</sup> IV once per day on days 1 to 5
+**Dosage for patients with previous pelvic radiation or other chemotherapy is 1200 mg/m<sup>2</sup>
+**Dose could be increased by 300 mg/m<sup>2</sup> or decreased by 20% depending on toxicity
-*[[Ifosfamide (Ifex)]] 1500 mg/m2 IV once per day on days 1 to 5
+====Supportive medications====
-**Dosage for patients with previous pelvic radiation or other chemotherapy is [[Ifosfamide (Ifex)]] 1200 mg/m2
+*[[Mesna (Mesnex)]] at 20% of ifosfamide dose (for example, 300 mg/m<sup>2</sup> for 1500 mg/m<sup>2</sup> dose of ifosfamide) IV given at 0, 4, and 8 hours after each dose of ifosfamide on days 1 to 5
-**Dose of [[Ifosfamide (Ifex)]] could be increased by 300 mg/m2 or decreased by 20% depending on toxicity
-*[[Mesna (Mesnex)]] at 20% of ifosfamide dose (for example, 300 mg/m2 for 1500 mg/m2 dose of ifosfamide) IV given at 0, 4, and 8 hours after each dose of ifosfamide on days 1 to 5
 '''21-day cycles'''
@@ Line 984: / Line 1,086: @@
 # Coleman RE, Harper PG, Gallagher C, Osborne R, Rankin EM, Silverstone AC, Slevin ML, Souhami RL, Tobias JS, Trask CW et al. A phase II study of ifosfamide in advanced and relapsed carcinoma of the cervix. Cancer Chemother Pharmacol. 1986;18(3):280-3. [http://www.ncbi.nlm.nih.gov/pubmed/3802384 PubMed]
 # Sutton GP, Blessing JA, McGuire WP, Patton T, Look KY. Phase II trial of ifosfamide and mesna in patients with advanced or recurrent squamous carcinoma of the cervix who had never received chemotherapy: a Gynecologic Oncology Group study. Am J Obstet Gynecol. 1993 Mar;168(3 Pt 1):805-7. [http://www.ncbi.nlm.nih.gov/pubmed/8456884 PubMed]
-# Sutton GP, Blessing JA, DiSaia PJ, McGuire WP. Phase II study of ifosfamide and mesna in nonsquamous carcinoma of the cervix: a Gynecologic Oncology Group study. Gynecol Oncol. 1993 Apr;49(1):48-50. [http://www.sciencedirect.com/science/article/pii/S009082588371084X link to original article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/8482560 PubMed]
+# Sutton GP, Blessing JA, DiSaia PJ, McGuire WP. Phase II study of ifosfamide and mesna in nonsquamous carcinoma of the cervix: a Gynecologic Oncology Group study. Gynecol Oncol. 1993 Apr;49(1):48-50. [http://www.gynecologiconcology-online.net/article/S0090-8258(83)71084-X/abstract link to original article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/8482560 PubMed]
 ==Irinotecan (Camptosar) {{#subobject:e80134|Regimen=1}}==
@@ Line 992: / Line 1,094: @@
 |}
 ===Regimen {{#subobject:fe2b8e|Variant=1}}===
-Level of Evidence:
+{| border="1" style="text-align:center;" !align="left"
-<span
+|'''Study'''
+|[[Levels_of_Evidence#Evidence|'''Evidence''']]
+|-
+|[http://jco.ascopubs.org/content/15/2/625.long Verschraegen et al. 1997]
+|<span
 style="background:#EEEE00;
 padding:3px 6px 3px 6px;
@@ Line 999: / Line 1,105: @@
 border-width:2px;
 border-style:solid;">Phase II</span>
+|-
+|}
+====Chemotherapy====
+*[[Irinotecan (Camptosar)]] 125 mg/m<sup>2</sup> IV over 90 minutes once per day on days 1, 8, 15, 22
-*[[Irinotecan (Camptosar)]] 125 mg/m2 IV over 90 minutes once per day on days 1, 8, 15, 22
+====Supportive medications====
+*[[Diphenhydramine (Benadryl)]] 25 to 50 mg PO/IV every 6 hours as needed for diarrhea during irinotecan infusion
+*Atropine 1 mg IV every 6 hours as needed for diarrhea during irinotecan infusion
+*[[Loperamide (Lomotil)]] 4 mg PO as needed for each episode of delayed diarrhea between irinotecan infusions
 '''42-day cycles'''
-Supportive medications:
-*Diphenhydramine (Benadryl) 25-50 mg PO/IV every 6 hours as needed for diarrhea during irinotecan infusion
-*Atropine 1 mg IV every 6 hours as needed for diarrhea during irinotecan infusion
-*Loperamide 4 mg PO as needed for each episode of delayed diarrhea between irinotecan infusions
 ===References===
@@ Line 1,017: / Line 1,125: @@
 |[[#toc|back to top]]
 |}
-===Regimen #1, Kudelka et al. 1996 & Kudelka et al. 1997 {{#subobject:4c3e15|Variant=1}}===
-Level of Evidence:
+===Regimen #1, CI paclitaxel {{#subobject:6eac87|Variant=1}}===
-<span
+{| border="1" style="text-align:center;" !align="left"
+|'''Study'''
+|[[Levels_of_Evidence#Evidence|'''Evidence''']]
+|-
+|[http://jco.ascopubs.org/content/14/3/792.long McGuire et al. 1996]
+|<span
+style="background:#EEEE00;
+padding:3px 6px 3px 6px;
+border-color:black;
+border-width:2px;
+border-style:solid;">Phase II</span>
+|-
+|[http://jco.ascopubs.org/content/19/5/1275.long Curtin et al. 2001]
+|<span
 style="background:#EEEE00;
 padding:3px 6px 3px 6px;
@@ Line 1,025: / Line 1,146: @@
 border-width:2px;
 border-style:solid;">Phase II</span>
+|-
+|}
+====Chemotherapy====
+*[[Paclitaxel (Taxol)]] 170 mg/m<sup>2</sup> IV continuous infusion over 24 hours on day 1
+**Dosage for patients with previous pelvic radiation was 135 mg/m<sup>2</sup>
+**Dose could be changed to 110 or 200 mg/m<sup>2</sup> depending on toxicity
-*[[Paclitaxel (Taxol)]] 250 mg/m2 IV over 3 hours on day 1
+====Supportive medications====
-**Dose of [[Paclitaxel (Taxol)]] could be changed to 275, 225, or 200 mg/m2 depending on toxicity
+*[[Dexamethasone (Decadron)]] 20 mg PO/IV 14 and 7 hours prior to paclitaxel
+*[[Diphenhydramine (Benadryl)]] 50 mg IV 30 minutes prior to paclitaxel
+*[[Ranitidine (Zantac)]] 50 mg IV 30 minutes prior to paclitaxel
 '''21-day cycles'''
-Supportive medications:
+===Regimen #2 {{#subobject:4c3e15|Variant=1}}===
-*[[Dexamethasone (Decadron)]] 20 mg PO 14 and 7 hours prior to paclitaxel
+{| border="1" style="text-align:center;" !align="left"
-*Cimetidine (Tagamet) 300 mg IV 60 minutes prior to paclitaxel
+|'''Study'''
-*Diphenhydramine (Benadryl) 50 mg IV 60 minutes prior to paclitaxel
+|[[Levels_of_Evidence#Evidence|'''Evidence''']]
-*[[Filgrastim (Neupogen)]] 5 mcg/kg SC daily starting on day 2, 24 hours after chemotherapy, given until day 19 or until ANC greater or equal to 10,000
+|-
+|[http://clincancerres.aacrjournals.org/content/2/8/1285.long Kudelka et al. 1996]
-===Regimen #2, McGuire et al. 1996 & Curtin et al. 2001 {{#subobject:6eac87|Variant=1}}===
+|<span
-Level of Evidence:
-<span
 style="background:#EEEE00;
 padding:3px 6px 3px 6px;
@@ Line 1,045: / Line 1,172: @@
 border-width:2px;
 border-style:solid;">Phase II</span>
+|-
+|}
+====Chemotherapy====
+*[[Paclitaxel (Taxol)]] 250 mg/m<sup>2</sup> IV over 3 hours on day 1
+**Dose of [[Paclitaxel (Taxol)]] could be changed to 275, 225, or 200 mg/m<sup>2</sup> depending on toxicity
-*[[Paclitaxel (Taxol)]] 170 mg/m2 IV continuous infusion over 24 hours on day 1
+====Supportive medications====
-**Dosage for patients with previous pelvic radiation was [[Paclitaxel (Taxol)]] 135 mg/m2
+*[[Dexamethasone (Decadron)]] 20 mg PO 14 and 7 hours prior to paclitaxel
-**Dose of [[Paclitaxel (Taxol)]] could be changed to 110 or 200 mg/m2 depending on toxicity
+*[[Cimetidine (Tagamet)]] 300 mg IV 60 minutes prior to paclitaxel
+*[[Diphenhydramine (Benadryl)]] 50 mg IV 60 minutes prior to paclitaxel
+*[[Filgrastim (Neupogen)]] 5 mcg/kg SC once per day starting on day 2, 24 hours after chemotherapy, given until day 19 or until ANC greater or equal to 10,000
 '''21-day cycles'''
-Supportive medications:
-*[[Dexamethasone (Decadron)]] 20 mg PO/IV 14 and 7 hours prior to paclitaxel
-*Diphenhydramine (Benadryl) 50 mg IV 30 minutes prior to paclitaxel
-*Ranitidine (Zantac) 50 mg IV 30 minutes prior to paclitaxel
 ===References===
 # McGuire WP, Blessing JA, Moore D, Lentz SS, Photopulos G. Paclitaxel has moderate activity in squamous cervix cancer. A Gynecologic Oncology Group study. J Clin Oncol. 1996 Mar;14(3):792-5. [http://jco.ascopubs.org/content/14/3/792.long link to original article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/8622025 PubMed]
 # Kudelka AP, Winn R, Edwards CL, Downey G, Greenberg H, Dakhil SR, Freedman RS, Loyer E, Rusinkiewicz J, Gacrama P, Fueger R, Kavanagh JJ. Activity of paclitaxel in advanced or recurrent squamous cell cancer of the cervix. Clin Cancer Res. 1996 Aug;2(8):1285-8. [http://clincancerres.aacrjournals.org/content/2/8/1285.long link to original article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/9816298 PubMed] content property of [http://hemonc.org HemOnc.org]
-# '''Update:''' Kudelka AP, Winn R, Edwards CL, Downey G, Greenberg H, Dakhil SR, Freedman RS, LoCoco S, Umbreit J, Delmore JE, Arbuck S, Loyer E, Gacrama P, Fueger R, Kavanagh JJ. An update of a phase II study of paclitaxel in advanced or recurrent squamous cell cancer of the cervix. Anticancer Drugs. 1997 Aug;8(7):657-61. [http://www.ncbi.nlm.nih.gov/pubmed/9311440 PubMed]
+## '''Update:''' Kudelka AP, Winn R, Edwards CL, Downey G, Greenberg H, Dakhil SR, Freedman RS, LoCoco S, Umbreit J, Delmore JE, Arbuck S, Loyer E, Gacrama P, Fueger R, Kavanagh JJ. An update of a phase II study of paclitaxel in advanced or recurrent squamous cell cancer of the cervix. Anticancer Drugs. 1997 Aug;8(7):657-61. [http://www.ncbi.nlm.nih.gov/pubmed/9311440 PubMed]
 # Curtin JP, Blessing JA, Webster KD, Rose PG, Mayer AR, Fowler WC Jr, Malfetano JH, Alvarez RD. Paclitaxel, an active agent in nonsquamous carcinomas of the uterine cervix: a Gynecologic Oncology Group Study. J Clin Oncol. 2001 Mar 1;19(5):1275-8. [http://jco.ascopubs.org/content/19/5/1275.long link to original article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/11230468 PubMed]
@@ Line 1,069: / Line 1,198: @@
 |}
 ===Regimen {{#subobject:db8999|Variant=1}}===
-Level of Evidence:
+{| border="1" style="text-align:center;" !align="left"
-<span
+|'''Study'''
+|[[Levels_of_Evidence#Evidence|'''Evidence''']]
+|-
+|[http://www.gynecologiconcology-online.net/article/S0090-8258(08)00203-5/abstract Miller et al. 2008]
+|<span
 style="background:#EEEE00;
 padding:3px 6px 3px 6px;
@@ Line 1,076: / Line 1,209: @@
 border-width:2px;
 border-style:solid;">Phase II</span>
+|-
+|}
+====Chemotherapy====
+*[[Pemetrexed (Alimta)]] 900 mg/m<sup>2</sup> IV over 10 minutes once on day 1
-*[[Pemetrexed (Alimta)]] 900 mg/m2 IV over 10 minutes on day 1
+====Supportive medications====
+*Folic acid 350 to 600 mcg PO once per day, starting 7 days before pemetrexed, to continue throughout therapy
+*[[Cyanocobalamin (Vitamin B12)]] 1000 mcg IM once 7 days before pemetrexed (then 1000 mcg to be given every 9 weeks thereafter)
+*[[Dexamethasone (Decadron)]] 4 mg PO BID the day before, the day of, and day after pemetrexed
+*No NSAIDs (nonsteroidal anti-inflammatory drugs) for 2 days before or after pemetrexed
 '''21-day cycles'''
-Supportive medications:
-*Folic acid 350-600 mcg PO daily, starting 7 days before pemetrexed, to continue throughout therapy
-*[[Cyanocobalamin (Vitamin B12)]] 1000 mcg IM once 7 days before pemetrexed (then 1000 mcg to be given every 9 weeks thereafter)
-*[[Dexamethasone (Decadron)]] 4 mg PO BID the day before, the day of, and day after Pemetrexed (Alimta)
-*No NSAIDs (nonsteroidal anti-inflammatory drugs) for 2 days before or after pemetrexed
 ===References===
-# Miller DS, Blessing JA, Bodurka DC, Bonebrake AJ, Schorge JO; Gynecologic Oncology Group. Evaluation of pemetrexed (Alimta, LY231514) as second line chemotherapy in persistent or recurrent carcinoma of the cervix: a phase II study of the Gynecologic Oncology Group. Gynecol Oncol. 2008 Jul;110(1):65-70. Epub 2008 May 5. [http://www.sciencedirect.com/science/article/pii/S0090825808002035 link to original article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/18455781 PubMed]
+# Miller DS, Blessing JA, Bodurka DC, Bonebrake AJ, Schorge JO; Gynecologic Oncology Group. Evaluation of pemetrexed (Alimta, LY231514) as second line chemotherapy in persistent or recurrent carcinoma of the cervix: a phase II study of the Gynecologic Oncology Group. Gynecol Oncol. 2008 Jul;110(1):65-70. Epub 2008 May 5. [http://www.gynecologiconcology-online.net/article/S0090-8258(08)00203-5/abstract link to original article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/18455781 PubMed]
 ==Topotecan (Hycamtin) {{#subobject:720120|Regimen=1}}==
@@ Line 1,095: / Line 1,230: @@
 |[[#toc|back to top]]
 |}
-===Regimen #1, Bookman et al. 2000 {{#subobject:be1724|Variant=1}}===
+===Regimen #1, 4-week cycle {{#subobject:469fbe|Variant=1}}===
-Level of Evidence:
+{| border="1" style="text-align:center;" !align="left"
-<span
+|'''Study'''
+|[[Levels_of_Evidence#Evidence|'''Evidence''']]
+|-
+|[http://www.gynecologiconcology-online.net/article/S0090-8258(00)96024-4/abstract Muderspach et al. 2001]
+|<span
 style="background:#EEEE00;
 padding:3px 6px 3px 6px;
@@ Line 1,103: / Line 1,242: @@
 border-width:2px;
 border-style:solid;">Phase II</span>
+|-
+|}
+====Chemotherapy====
+*[[Topotecan (Hycamtin)]] 1.5 mg/m<sup>2</sup> IV over 30 minutes once per day on days 1 to 5
-*[[Topotecan (Hycamtin)]] 1.5 mg/m2 IV over 30 minutes once per day on days 1 to 5
+'''28-day cycles'''
-'''21-day cycles'''
+===Regimen #2, 3-week cycle {{#subobject:be1724|Variant=1}}===
+{| border="1" style="text-align:center;" !align="left"
-===Regimen #2, Muderspach et al. 2001 {{#subobject:469fbe|Variant=1}}===
+|'''Study'''
-Level of Evidence:
+|[[Levels_of_Evidence#Evidence|'''Evidence''']]
-<span
+|-
+|[http://www.gynecologiconcology-online.net/article/S0090-8258(00)95807-4/abstract Bookman et al. 2000 (GOG 127-F)]
+|<span
 style="background:#EEEE00;
 padding:3px 6px 3px 6px;
@@ Line 1,116: / Line 1,261: @@
 border-width:2px;
 border-style:solid;">Phase II</span>
+|-
+|}
+====Chemotherapy====
+*[[Topotecan (Hycamtin)]] 1.5 mg/m<sup>2</sup> IV over 30 minutes once per day on days 1 to 5
-*[[Topotecan (Hycamtin)]] 1.5 mg/m2 IV over 30 minutes once per day on days 1 to 5
+'''21-day cycles'''
-'''28-day cycles'''
 ===References===
-# Bookman MA, Blessing JA, Hanjani P, Herzog TJ, Andersen WA. Topotecan in squamous cell carcinoma of the cervix: A Phase II study of the Gynecologic Oncology Group. Gynecol Oncol. 2000 Jun;77(3):446-9. [http://www.sciencedirect.com/science/article/pii/S0090825800958074 link to original article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/10831357 PubMed]
+# Bookman MA, Blessing JA, Hanjani P, Herzog TJ, Andersen WA. Topotecan in squamous cell carcinoma of the cervix: A Phase II study of the Gynecologic Oncology Group. Gynecol Oncol. 2000 Jun;77(3):446-9. [http://www.gynecologiconcology-online.net/article/S0090-8258(00)95807-4/abstract link to original article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/10831357 PubMed]
-# Muderspach LI, Blessing JA, Levenback C, Moore JL Jr. A Phase II study of topotecan in patients with squamous cell carcinoma of the cervix: a gynecologic oncology group study. Gynecol Oncol. 2001 May;81(2):213-5. [http://www.sciencedirect.com/science/article/pii/S0090825800960244 link to original article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/11354055 PubMed]
+# Muderspach LI, Blessing JA, Levenback C, Moore JL Jr. A Phase II study of topotecan in patients with squamous cell carcinoma of the cervix: a gynecologic oncology group study. Gynecol Oncol. 2001 May;81(2):213-5. [http://www.gynecologiconcology-online.net/article/S0090-8258(00)96024-4/abstract link to original article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/11354055 PubMed]
 ==Topotecan & Paclitaxel {{#subobject:PYR2|Regimen=1}}==
@@ Line 1,148: / Line 1,295: @@
 ''In Tewari et al. 2014 (GOG 240), topotecan & paclitaxel +/- bevacizumab regimens were "associated with a significantly higher risk of progression" as compared to cisplatin & paclitaxel +/- bevacizumab regimens.''
-*[[Topotecan (Hycamtin)]] 0.75 mg/m2 IV once per day on days 1 to 3
+====Chemotherapy====
-*[[Paclitaxel (Taxol)]] 175 mg/m2 IV once on day 1
+*[[Topotecan (Hycamtin)]] 0.75 mg/m<sup>2</sup> IV once per day on days 1 to 3
+*[[Paclitaxel (Taxol)]] 175 mg/m<sup>2</sup> IV once on day 1
 '''21-day cycles; given until progression of disease, unacceptable toxicity, or if the patient had a complete response'''
@@ Line 1,179: / Line 1,327: @@
 ''In Tewari et al. 2014 (GOG 240), topotecan & paclitaxel +/- bevacizumab regimens were "associated with a significantly higher risk of progression" as compared to cisplatin & paclitaxel +/- bevacizumab regimens.''
-*[[Topotecan (Hycamtin)]] 0.75 mg/m2 IV once per day on days 1 to 3
+====Chemotherapy====
-*[[Paclitaxel (Taxol)]] 175 mg/m2 IV once on day 1
+*[[Topotecan (Hycamtin)]] 0.75 mg/m<sup>2</sup> IV once per day on days 1 to 3
+*[[Paclitaxel (Taxol)]] 175 mg/m<sup>2</sup> IV once on day 1
 *[[Bevacizumab (Avastin)]] 15 mg/kg IV once on day 1
@@ Line 1,193: / Line 1,342: @@
 |[[#toc|back to top]]
 |}
-===Regimen #1, Muggia et al. 2004 & Muggia et al. 2005 {{#subobject:ba6a7e|Variant=1}}===
+===Regimen #1, 2 weeks on, 1 week off dosing {{#subobject:ba6a7e|Variant=1}}===
-Level of Evidence:
+{| border="1" style="text-align:center;" !align="left"
-<span
+|'''Study'''
+|[[Levels_of_Evidence#Evidence|'''Evidence''']]
+|-
+|[http://www.gynecologiconcology-online.net/article/S0090-8258(03)00770-4/abstract Muggia et al. 2004]
+|<span
 style="background:#EEEE00;
 padding:3px 6px 3px 6px;
@@ Line 1,201: / Line 1,354: @@
 border-width:2px;
 border-style:solid;">Phase II</span>
+|-
-*[[Vinorelbine (Navelbine)]] 30 mg/m2 IV once per day on days 1 & 8
+|[http://www.gynecologiconcology-online.net/article/S0090-8258(04)00774-7/abstract Muggia et al. 2005]
+|<span
+style="background:#EEEE00;
+padding:3px 6px 3px 6px;
+border-color:black;
+border-width:2px;
+border-style:solid;">Phase II</span>
+|-
+|}
+====Chemotherapy====
+*[[Vinorelbine (Navelbine)]] 30 mg/m<sup>2</sup> IV once per day on days 1 & 8
 '''21-day cycles'''
-===Regimen #2, Morris et al. 1998 {{#subobject:e1af3|Variant=1}}===
+===Regimen #2, weekly dosing {{#subobject:e1af3|Variant=1}}===
-Level of Evidence:
+{| border="1" style="text-align:center;" !align="left"
-<span
+|'''Study'''
+|[[Levels_of_Evidence#Evidence|'''Evidence''']]
+|-
+|[http://jco.ascopubs.org/content/16/3/1094.long Morris et al. 1998]
+|<span
 style="background:#EEEE00;
 padding:3px 6px 3px 6px;
@@ Line 1,214: / Line 1,381: @@
 border-width:2px;
 border-style:solid;">Phase II</span>
+|-
-*[[Vinorelbine (Navelbine)]] 30 mg/m2 IV on day 1
+|}
+====Chemotherapy====
+*[[Vinorelbine (Navelbine)]] 30 mg/m<sup>2</sup> IV once on day 1
 '''7-day cycles'''
@@ Line 1,221: / Line 1,390: @@
 ===References===
 # Morris M, Brader KR, Levenback C, Burke TW, Atkinson EN, Scott WR, Gershenson DM. Phase II study of vinorelbine in advanced and recurrent squamous cell carcinoma of the cervix. J Clin Oncol. 1998 Mar;16(3):1094-8. [http://jco.ascopubs.org/content/16/3/1094.long link to original article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/9508195 PubMed]
-# Muggia FM, Blessing JA, Method M, Miller DS, Johnson GA, Lee RB, Menzin A; Gynecologic Oncology Group study. Evaluation of vinorelbine in persistent or recurrent squamous cell carcinoma of the cervix: a Gynecologic Oncology Group study. Gynecol Oncol. 2004 Feb;92(2):639-43. [http://www.sciencedirect.com/science/article/pii/S0090825803007704 link to original article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/14766259 PubMed]
+# Muggia FM, Blessing JA, Method M, Miller DS, Johnson GA, Lee RB, Menzin A; Gynecologic Oncology Group study. Evaluation of vinorelbine in persistent or recurrent squamous cell carcinoma of the cervix: a Gynecologic Oncology Group study. Gynecol Oncol. 2004 Feb;92(2):639-43. [http://www.gynecologiconcology-online.net/article/S0090-8258(03)00770-4/abstract link to original article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/14766259 PubMed]
-# Muggia FM, Blessing JA, Waggoner S, Berek JS, Monk BJ, Sorosky J, Pearl ML. Evaluation of vinorelbine in persistent or recurrent nonsquamous carcinoma of the cervix: a Gynecologic Oncology Group Study. Gynecol Oncol. 2005 Jan;96(1):108-11. [http://www.sciencedirect.com/science/article/pii/S0090825804007747 link to original article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/15589588 PubMed]
+# Muggia FM, Blessing JA, Waggoner S, Berek JS, Monk BJ, Sorosky J, Pearl ML. Evaluation of vinorelbine in persistent or recurrent nonsquamous carcinoma of the cervix: a Gynecologic Oncology Group Study. Gynecol Oncol. 2005 Jan;96(1):108-11. [http://www.gynecologiconcology-online.net/article/S0090-8258(04)00774-7/abstract link to original article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/15589588 PubMed]
+[[Category:Chemotherapy regimens]]
+[[Category:Solid oncology regimens]]
+[[Category:Gynecologic oncology regimens]]

Difference between revisions of "Cervical cancer"

Revision as of 01:51, 13 August 2016

Chemoradiation

Cisplatin & RT

Regimen #1

Chemoradiotherapy

Brachytherapy

Regimen #2

Chemoradiotherapy

Brachytherapy

Regimen #3

Chemoradiotherapy

Brachytherapy

References

Cisplatin & RT -> Hysterectomy

Regimen

Chemoradiation

References

Cisplatin, Fluorouracil, RT

Regimen

Chemotherapy

Concurrent radiation therapy

References

Cisplatin, Fluorouracil, Hydroxyurea, RT

Regimen

Chemoradiotherapy

Brachytherapy

References

Cisplatin, Gemcitabine, RT

Regimen

Chemoradiotherapy

Brachytherapy

Chemotherapy

References

Fluorouracil & RT

Regimen

Chemoradiotherapy

References

Hydroxyurea & RT

Regimen

Chemoradiotherapy

Brachytherapy

References

Radiation therapy

Regimen

References

RT -> Hysterectomy

Regimen

References

Neoadjuvant chemotherapy

Cisplatin & Paclitaxel

Regimen

Chemotherapy

Supportive medications

References

Locally Advanced or Metastatic disease

Bevacizumab (Avastin)

Regimen

Chemotherapy

References

Carboplatin (Paraplatin)

Regimen

Chemotherapy

References

Carboplatin & Docetaxel

Regimen

Chemotherapy

Supportive medications

References

Carboplatin & Paclitaxel

Regimen

Chemotherapy

References

Cisplatin (Platinol)

Regimen

Chemotherapy

References

Cisplatin & Gemcitabine

Regimen #1, 3-week cycles

Chemotherapy