Cervical cancer

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 Summer B. Dewdney, MD
Rush University
Chicago, IL
48 regimens on this page
65 variants on this page


Guidelines

ESMO

Older

NCCN

Neoadjuvant chemotherapy

Cisplatin & Paclitaxel

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Regimen

Study Years of enrollment Evidence
Park et al. 2004 NR in abstract Phase II

Chemotherapy

Supportive medications

10-day cycle for 3 cycles

Subsequent treatment

  • Clinical response assessed after 3 cycles with pelvic examination and MRI. Treatment followed by surgery or radiation therapy.

References

  1. 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

Definitive chemoradiotherapy for locally advanced disease

Carboplatin & RT

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Carboplatin & RT: Carboplatin & Radiation Therapy

Regimen

Study Years of enrollment Evidence Comparator Comparative Efficacy
Veerasarn et al. 2006 2001-2003 Phase III (C) Carboplatin, UFT, RT Did not meet primary endpoints of TTP/OS

Chemotherapy

7-day cycle for 5 to 6 cycles, according to RT duration

Radiotherapy

One course

References

  1. Veerasarn V, Lorvidhaya V, Kamnerdsupaphon P, Suntornpong N, Sangruchi S, Lertsanguansinchai P, Khorprasert C, Sookpreedee L, Udompunturak S. A randomized phase III trial of concurrent chemoradiotherapy in locally advanced cervical cancer: preliminary results. Gynecol Oncol. 2007 Jan;104(1):15-23. Epub 2006 Sep 25. link to original article contains verified protocol PubMed
  2. CALLA: NCT03830866

Cisplatin & RT

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Cisplatin & RT: Cisplatin & Radiation Therapy

Regimen variant #1, 40.8 Gy, no cap

Study Years of enrollment Evidence Comparator Comparative Efficacy
Rose et al. 1999 (GOG 120) 1992-1997 Phase III (E-esc) 1. Cisplatin, Fluorouracil, Hydroxyurea, RT Did not meet primary endpoints of PFS/OS
2. Hydroxyurea & RT Superior OS

This regimen was intended for stage IIB disease.

Chemotherapy

  • Cisplatin (Platinol) 40 mg/m2 IV over 60 minutes once per day on days 1, 8, 15, 22, 29, 36, given 4 hours before radiation

Radiotherapy, part 1

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

Radiotherapy, part 2

Regimen variant #2, 45 Gy, capped cisplatin

Study Years of enrollment Evidence Comparator Comparative Efficacy
Keys et al. 1999 (GOG 123) 1992-1997 Phase III (E-esc) RT Superior OS
Lanciano et al. 2005 (GOG 165) 1997-2000 Phase III (E-switch-ic) Fluorouracil & RT Might have superior ORR

Chemotherapy

  • Cisplatin (Platinol) 40 mg/m2 (maximum dose of 70 mg) IV once per day on days 1, 8, 15, 22, 29, 36, given 4 hours before radiation

Radiotherapy, part 1

5-week course, followed by:

Radiotherapy, part 2

  • GOG 123: Brachytherapy 30 Gy to point A for a total dose of 75 Gy
  • GOG 165: brachytherapy as follows:
    • 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

Subsequent treatment

Regimen variant #3, 45 Gy, uncapped cisplatin

Study Years of enrollment Evidence Comparator Comparative Efficacy
DiSilvestro et al. 2014 (GOG 219) 2006-2009 Phase III (C) Cisplatin, Tirapazamine, RT Did not meet primary endpoint of PFS

Chemotherapy

Radiotherapy, part 1

  • Concurrent radiation therapy: 1.8 Gy x 23 to 25 fractions, for an initial dose of 41.4 to 45 Gy

5-week course, followed by:

Radiotherapy, part 2

Regimen variant #4, 45 Gy, no cap

Study Years of enrollment Evidence Comparator Comparative Efficacy
Pearcey et al. 2002 1991-1996 Phase III (E-esc) RT Did not meet primary endpoint of OS36
Zuliani et al. 2014 2003-2010 Phase III (E-esc) RT Superior OS1
(HR 0.53, 95% CI 0.31-0.92)

1Reported efficacy is based on the 2020 update.

Chemotherapy

Radiotherapy

5-week course

Subsequent treatment

  • Pearcey et al. 2002: Brachytherapy; see paper for details

Regimen variant #5, 50 Gy, no cap

Study Years of enrollment Evidence Comparator Comparative Efficacy
Lutgens et al. 2016 (RADCHOC) 2003-2009 Phase III (C) RT-HT Did not meet primary endpoint of EFS
Shrivastava et al. 2018 (CRACx) 2003-2011 Phase III (E-esc) RT Seems to have superior OS

Chemotherapy

Supportive medications

7-day cycle for 5 cycles

Radiotherapy, part 1

5-week course, followed by:

Radiotherapy, part 2

  • See paper for details

Regimen variant #6, 50.4 Gy, no cap

Study Years of enrollment Evidence Comparator Comparative Efficacy
Dueñas-González et al. 2011 (B9E-MC-JHQS) 2002-2004 Phase III (C) Cisplatin, Gemcitabine, RT Seems to have inferior OS
Sehouli et al. 2012 2003-2008 Phase III (C) Carboplatin & Paclitaxel, then RT Did not meet primary endpoint of PFS

Chemotherapy

  • Cisplatin (Platinol) 40 mg/m2 IV over 60 minutes once per day on days 1, 8, 15, 22, 29, 36, given 1 to 2 hours before radiation

Radiotherapy, part 1

6-week course, followed by:

Radiotherapy, part 2

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

Regimen variant #7, 51 Gy, no cap

Study Years of enrollment Evidence Comparator Comparative Efficacy
Rose et al. 1999 (GOG 120) 1992-1997 Phase III (E-esc) 1. Cisplatin, Fluorouracil, Hydroxyurea, RT Did not meet primary endpoints of PFS/OS
2. Hydroxyurea & RT Superior OS

This regimen was intended for stage III or IVA disease.

Chemotherapy

  • Cisplatin (Platinol) 40 mg/m2 IV over 60 minutes once per day on days 1, 8, 15, 22, 29, 36, given 4 hours before radiation

Radiotherapy, part 1

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

Radiotherapy, part 2

References

  1. GOG 120: 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
  2. GOG 123: 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
  3. NCIC-CTG: Pearcey R, Brundage M, Drouin P, Jeffrey J, Johnston D, Lukka H, MacLean G, Souhami L, Stuart G, Tu D. Phase III trial comparing radical radiotherapy with and without cisplatin chemotherapy in patients with advanced squamous cell cancer of the cervix. J Clin Oncol. 2002 Feb 15;20(4):966-72. link to original article contains verified protocol PubMed
  4. GOG 165: 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 NCT00003078
  5. B9E-MC-JHQS: 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 NCT00191100
  6. Sehouli J, Runnebaum IB, Fotopoulou C, Blohmer U, Belau A, Leber H, Hanker LC, Hartmann W, Richter R, Keyver-Paik MD, Oberhoff C, Heinrich G, du Bois A, Olbrich C, Simon E, Friese K, Kimmig R, Boehmer D, Lichtenegger W, Kuemmel S; NOGGO; AGO. A randomized phase III adjuvant study in high-risk cervical cancer: simultaneous radiochemotherapy with cisplatin (S-RC) versus systemic paclitaxel and carboplatin followed by percutaneous radiation (PC-R): a NOGGO-AGO Intergroup Study. Ann Oncol. 2012 Sep;23(9):2259-64. Epub 2012 Feb 21. link to original article contains verified protocol PubMed
  7. GOG 219: DiSilvestro PA, Ali S, Craighead PS, Lucci JA, Lee YC, Cohn DE, Spirtos NM, Tewari KS, Muller C, Gajewski WH, Steinhoff MM, Monk BJ. Phase III randomized trial of weekly cisplatin and irradiation versus cisplatin and tirapazamine and irradiation in stages IB2, IIA, IIB, IIIB, and IVA cervical carcinoma limited to the pelvis: a Gynecologic Oncology Group study. J Clin Oncol. 2014 Feb 10;32(5):458-64. Epub 2014 Jan 6. link to original article link to PMC article contains verified protocol PubMed NCT00262821
  8. Zuliani AC, Esteves SC, Teixeira LC, Teixeira JC, de Souza GA, Sarian LO. Concomitant cisplatin plus radiotherapy and high-dose-rate brachytherapy versus radiotherapy alone for stage IIIB epidermoid cervical cancer: a randomized controlled trial. J Clin Oncol. 2014 Feb 20;32(6):542-7. Epub 2014 Jan 21. link to original article PubMed
    1. Update: Fachini AMD, Zuliani AC, Sarian LO, Teixeira JC, Esteves SCB, da Costa Machado H, Zeferino LC. Long-term outcomes of concomitant cisplatin plus radiotherapy versus radiotherapy alone in patients with stage IIIB squamous cervical cancer: A randomized controlled trial. Gynecol Oncol. 2021 Feb;160(2):379-383. Epub 2020 Dec 16. link to original article PubMed
  9. RADCHOC: Lutgens LC, Koper PC, Jobsen JJ, van der Steen-Banasik EM, Creutzberg CL, van den Berg HA, Ottevanger PB, van Rhoon GC, van Doorn HC, Houben R, van der Zee J. Radiation therapy combined with hyperthermia versus cisplatin for locally advanced cervical cancer: Results of the randomized RADCHOC trial. Radiother Oncol. 2016 Sep;120(3):378-382. Epub 2016 Feb 17. link to original article contains protocol PubMed
  10. CRACx: Shrivastava S, Mahantshetty U, Engineer R, Chopra S, Hawaldar R, Hande V, Kerkar RA, Maheshwari A, Shylasree TS, Ghosh J, Bajpai J, Gurram L, Gulia S, Gupta S; Gynecologic Disease Management Group. Cisplatin chemoradiotherapy vs radiotherapy in FIGO stage IIIB squamous cell carcinoma of the uterine cervix: a randomized clinical trial. JAMA Oncol. 2018 Apr 1;4(4):506-513. link to original article contains verified protocol in supplement PubMed NCT00193791
  11. CALLA: NCT03830866

Cisplatin & Fluorouracil (CF) & RT

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CF & RT: Cisplatin, Fluorouracil Radiation Therapy

Regimen variant #1, 70/4000 x 4

Study Years of enrollment Evidence Comparator Comparative Efficacy
Whitney et al. 1999 (GOG 85/SWOG 8695) 1986-1990 Phase III (E-esc) Hydroxyurea & RT Seems to have superior OS
Peters et al. 2000 (GOG 109/SWOG-8797) 1991-1996 Phase III (E-esc) Radiation therapy Superior OS

Chemotherapy

21-day cycle for 4 cycles

Radiotherapy

  • Concurrent radiation therapy: 1.7 Gy x 29 fractions, for a total dose of 49.3 Gy, starting on cycle 1 day 1
    • Patients with positive high common iliac lymph nodes also received 1.5 Gy x 30 fractions, for a total dose of 45 Gy

6-week course

Regimen variant #2, 75/4000 x 3

Study Years of enrollment Evidence Comparator Comparative Efficacy
Morris et al. 1999 1990-1997 Phase III (E-esc) Radiation therapy Superior OS

Chemotherapy

21-day cycle for 3 cycles

Radiotherapy

  • Concurrent radiation therapy: 1.8 Gy x 25 fractions, for a total dose of 45 Gy, starting on cycle 1 day 0 or 1

5-week course

Subsequent treatment

  • Brachytherapy (see paper for details)

References

  1. Morris M, Eifel PJ, Lu J, Grigsby PW, Levenback C, Stevens RE, Rotman M, Gershenson DM, Mutch DG. Pelvic radiation with concurrent chemotherapy compared with pelvic and para-aortic radiation for high-risk cervical cancer. N Engl J Med. 1999 Apr 15;340(15):1137-43. link to original article contains verified protocol PubMed
  2. GOG 85/SWOG 8695: 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
  3. GOG 109/SWOG-8797: 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 (CF) & Hydroxyurea, RT

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Cisplatin, Fluorouracil, Hydroxyurea, RT: Cisplatin, Fluorouracil, Hydroxyurea, Radiation Therapy

Regimen

Study Years of enrollment Evidence Comparator Comparative Efficacy
Rose et al. 1999 (GOG 120) 1992-1997 Phase III (E-esc) 1. Cisplatin & RT Did not meet primary endpoints of PFS/OS
2. Hydroxyurea & RT Superior OS

Chemotherapy

28-day cycle for 2 cycles

Radiotherapy, part 1

  • 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

5- to 6-week course, followed by:

Radiotherapy, part 2

References

  1. GOG 120: 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 (GC) & RT

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Cisplatin, Gemcitabine, RT: Cisplatin, Gemcitabine, Radiation Therapy

Regimen

Study Years of enrollment Evidence Comparator Comparative Efficacy
Dueñas-González et al. 2011 (B9E-MC-JHQS) 2002-2004 Phase III (E-esc) Cisplatin & RT Seems to have superior OS
Cetina et al. 2013 2004-2009 Non-randomized portion of RCT

Chemotherapy

  • 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

Radiotherapy

6-week course

Subsequent treatment

References

  1. B9E-MC-JHQS: 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 NCT00191100
  2. Cetina L, González-Enciso A, Cantú D, Coronel J, Pérez-Montiel D, Hinojosa J, Serrano A, Rivera L, Poitevin A, Mota A, Trejo E, Montalvo G, Muñoz D, Robles-Flores J, de la Garza J, Chanona J, Jiménez-Lima R, Wegman T, Dueñas-González A. Brachytherapy versus radical hysterectomy after external beam chemoradiation with gemcitabine plus cisplatin: a randomized, phase III study in IB2-IIB cervical cancer patients. Ann Oncol. 2013 Aug;24(8):2043-7. Epub 2013 Apr 21. link to original article contains protocol PubMed

Fluorouracil & RT

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5-FU & RT: 5-FluouroUracil & Radiation Therapy

Regimen

Study Years of enrollment Evidence Comparator Comparative Efficacy
Lanciano et al. 2005 (GOG 165) 1997-2000 Phase III (E-switch-ic) Cisplatin & RT Might have inferior ORR

Chemotherapy

  • Fluorouracil (5-FU) 225 mg/m2/day IV continuous infusion over 120 hours, started on day 1 (total dose per cycle: 1125 mg/m2)

7-day cycle for 6 cycles

Radiotherapy, part 1

6-week course, followed by:

Radiotherapy, part 2

  • Parametrial boost of 5.4 to 9 Gy was administered to the involved parametrium after whole pelvic RT was complete

References

  1. GOG 165: 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 NCT00003078

Fluorouracil, Mitomycin, RT

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Fluorouracil, Mitomycin, RT: Fluorouracil, Mitomycin, Radiation Therapy

Regimen

Study Years of enrollment Evidence Comparator Comparative Efficacy
Lorvidhava et al. 2003 1988-1994 Phase III (E-esc) RT Superior DFS

Here for historic reference.

Chemotherapy

Radiotherapy

References

  1. Lorvidhaya V, Chitapanarux I, Sangruchi S, Lertsanguansinchai P, Kongthanarat Y, Tangkaratt S, Visetsiri E. Concurrent mitomycin C, 5-fluorouracil, and radiotherapy in the treatment of locally advanced carcinoma of the cervix: a randomized trial. Int J Radiat Oncol Biol Phys. 2003 Apr 1;55(5):1226-32. link to original article PubMed

Hydroxyurea & RT

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Hydroxyurea & RT: Hydroxyurea & Radiation Therapy

Regimen

Study Years of enrollment Evidence Comparator Comparative Efficacy
Hreshchyshyn et al. 1979 (GOG 04) 1970-1976 Phase III (E-esc) Radiation therapy Seems to have superior OS
Whitney et al. 1999 (GOG 85/SWOG 8695) 1986-1990 Phase III (C) Cisplatin, Fluorouracil, RT Seems to have inferior OS
Rose et al. 1999 (GOG 120) 1992-1997 Phase III (C) 1. Cisplatin & RT Inferior OS
2. Cisplatin, Fluorouracil, Hydroxyurea, RT Inferior OS

Chemotherapy

  • Hydroxyurea (Hydrea) 2000 mg/m2 PO two times per week, given 2 hours before radiation on weeks 1 to 6

Radiotherapy, part 1

  • 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:

Radiotherapy, part 2

References

  1. 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 original article PubMed
  2. GOG 120: 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
  3. GOG 85/SWOG 8695: 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 Years of enrollment Evidence Comparator Comparative Efficacy
Hreshchyshyn et al. 1979 (GOG 04) 1970-1976 Phase III (C) Hydroxyurea & RT Seems to have inferior OS
Benedetti-Panici et al. 2002 1990-1996 Phase III (C) NACT, then surgery Inferior OS
Morris et al. 1999 1990-1997 Phase III (C) Cisplatin & RT Inferior OS
Peters et al. 2000 (GOG 109/SWOG-8797) 1991-1996 Phase III (C) Cisplatin, Fluorouracil, RT Inferior OS
Pearcey et al. 2002 1991-1996 Phase III (C) Cisplatin & RT Did not meet primary endpoint of OS36
Keys et al. 1999 (GOG 123) 1992-1997 Phase III (C) Cisplatin & RT Inferior OS
Shrivastava et al. 2018 (CRACx) 2003-2011 Phase III (C) Cisplatin & RT Seems to have inferior OS
Sugiyama et al. 2014 (JGOG-DT101) 2004-2006 Phase III (C) Z-100 & RT Did not meet primary endpoint of OS
Srivastava et al. 2013 2006-2008 Phase III (C) Cisplatin & RT Did not meet primary endpoint of LRFS
Huang et al. 2021 (STARS) 2008-2018 Phase III (C) 1. Cisplatin & RT Did not meet primary endpoint of DFS
2. Cisplatin & Paclitaxel x2, then RT, then Cisplatin & Paclitaxel x2 Seems to have inferior OS

Demonstrably inferior; here for reference purposes only.

Radiotherapy

Subsequent treatment

References

  1. GOG 04: 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 original article PubMed
  2. DiSaia PJ, Bundy BN, Curry SL, Schlaerth J, Thigpen JT. Phase III study on the treatment of women with cervical cancer, stage IIB, IIIB, and IVA (confined to the pelvis and/or periaortic nodes), with radiotherapy alone versus radiotherapy plus immunotherapy with intravenous Corynebacterium parvum: a Gynecologic Oncology Group Study. Gynecol Oncol. 1987 Mar;26(3):386-97. link to original article PubMed
  3. Morris M, Eifel PJ, Lu J, Grigsby PW, Levenback C, Stevens RE, Rotman M, Gershenson DM, Mutch DG. Pelvic radiation with concurrent chemotherapy compared with pelvic and para-aortic radiation for high-risk cervical cancer. N Engl J Med. 1999 Apr 15;340(15):1137-43. link to original article contains verified protocol PubMed
  4. GOG 123: 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
  5. GOG 109/SWOG-8797: 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
  6. Benedetti-Panici P, Greggi S, Colombo A, Amoroso M, Smaniotto D, Giannarelli D, Amunni G, Raspagliesi F, Zola P, Mangioni C, Landoni F. Neoadjuvant chemotherapy and radical surgery versus exclusive radiotherapy in locally advanced squamous cell cervical cancer: results from the Italian multicenter randomized study. J Clin Oncol. 2002 Jan 1;20(1):179-88. link to original article PubMed
  7. Pearcey R, Brundage M, Drouin P, Jeffrey J, Johnston D, Lukka H, MacLean G, Souhami L, Stuart G, Tu D. Phase III trial comparing radical radiotherapy with and without cisplatin chemotherapy in patients with advanced squamous cell cancer of the cervix. J Clin Oncol. 2002 Feb 15;20(4):966-72. link to original article contains verified protocol PubMed
  8. Srivastava K, Paul S, Chufal KS, Shamsundar SD, Lal P, Pant MC, Bhatt M, Singh S, Gupta R. Concurrent chemoradiation versus radiotherapy alone in cervical carcinoma: a randomized phase III trial. Asia Pac J Clin Oncol. 2013 Dec;9(4):349-56. Epub 2013 May 27. link to original article PubMed
  9. JGOG-DT101: Sugiyama T, Fujiwara K, Ohashi Y, Yokota H, Hatae M, Ohno T, Nagai Y, Mitsuhashi N, Ochiai K, Noda K. Phase III placebo-controlled double-blind randomized trial of radiotherapy for stage IIB-IVA cervical cancer with or without immunomodulator Z-100: a JGOG study. Ann Oncol. 2014 May;25(5):1011-7. Epub 2014 Feb 25. link to original article PubMed UMIN C000000221
  10. CRACx: Shrivastava S, Mahantshetty U, Engineer R, Chopra S, Hawaldar R, Hande V, Kerkar RA, Maheshwari A, Shylasree TS, Ghosh J, Bajpai J, Gurram L, Gulia S, Gupta S; Gynecologic Disease Management Group. Cisplatin chemoradiotherapy vs radiotherapy in FIGO stage IIIB squamous cell carcinoma of the uterine cervix: a randomized clinical trial. JAMA Oncol. 2018 Apr 1;4(4):506-513. link to original article contains verified protocol in supplement PubMed NCT00193791
  11. STARS: Huang H, Feng YL, Wan T, Zhang YN, Cao XP, Huang YW, Xiong Y, Huang X, Zheng M, Li YF, Li JD, Chen GD, Li H, Chen YL, Ma LG, Yang HY, Li L, Yao SZ, Ye WJ, Tu H, Huang QD, Liang LZ, Liu FY, Liu Q, Liu JH. Effectiveness of Sequential Chemoradiation vs Concurrent Chemoradiation or Radiation Alone in Adjuvant Treatment After Hysterectomy for Cervical Cancer: The STARS Phase 3 Randomized Clinical Trial. JAMA Oncol. 2021 Mar 1;7(3):361-369. link to original article link to PMC article PubMed NCT00806117

Adjuvant therapy

Carboplatin & Ifosfamide

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Regimen

Study Years of enrollment Evidence Comparator Comparative Efficacy
Blohmer et al. 2011 (NOGGO-AGO) 1999-2001 Phase III (C) See link See link

Note: to our knowledge, this regimen was not tested as an experimental arm in an RCT prior to becoming a standard comparator arm.

Preceding treatment

Chemotherapy

Supportive medications

21-day cycle for 4 cycles

Subsequent treatment

References

  1. NOGGO-AGO: Blohmer JU, Paepke S, Sehouli J, Boehmer D, Kolben M, Würschmidt F, Petry KU, Kimmig R, Elling D, Thomssen C, von Minckwitz G, Möbus V, Hinke A, Kümmel S, Budach V, Lichtenegger W, Schmid P; NOGGO; AGO. Randomized phase III trial of sequential adjuvant chemoradiotherapy with or without erythropoietin Alfa in patients with high-risk cervical cancer: results of the NOGGO-AGO intergroup study. J Clin Oncol. 2011 Oct 1;29(28):3791-7. Epub 2011 Aug 22. link to original article contains verified protocol PubMed

Cisplatin & Gemcitabine (GC)

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Regimen

Study Years of enrollment Evidence
Dueñas-González et al. 2011 (B9E-MC-JHQS) 2002-2004 Non-randomized portion of RCT

Preceding treatment

Chemotherapy

21-day cycle for 2 cycles

References

  1. B9E-MC-JHQS: 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 NCT00191100

Radiation therapy

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Regimen

Study Years of enrollment Evidence Comparator Comparative Efficacy
Blohmer et al. 2011 (NOGGO-AGO) 1999-2001 Phase III (C) See link See link

Preceding treatment

Radiotherapy

  • External beam radiotherapy: 1.8 Gy for 28 fractions, for a total dose of 50.4 Gy
  • If resection margins positive, patients received one of the following:

6-week course

References

  1. NOGGO-AGO: Blohmer JU, Paepke S, Sehouli J, Boehmer D, Kolben M, Würschmidt F, Petry KU, Kimmig R, Elling D, Thomssen C, von Minckwitz G, Möbus V, Hinke A, Kümmel S, Budach V, Lichtenegger W, Schmid P; NOGGO; AGO. Randomized phase III trial of sequential adjuvant chemoradiotherapy with or without erythropoietin Alfa in patients with high-risk cervical cancer: results of the NOGGO-AGO intergroup study. J Clin Oncol. 2011 Oct 1;29(28):3791-7. Epub 2011 Aug 22. link to original article contains verified protocol PubMed

Persistent, recurrent, or metastatic disease, first-line therapy

Carboplatin monotherapy

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Regimen

Study Years of enrollment Evidence
Weiss et al. 1990 NR in abstract Phase II

Chemotherapy

28-day cycles

References

  1. Weiss GR, Green S, Hannigan EV, Boutselis JG, Surwit EA, Wallace DL, Alberts DS; SWOG. 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 variant #1, 6 cycles

Study Years of enrollment Evidence
Takekida et al. 2010 NR in abstract Phase II

Chemotherapy

Supportive medications

21-day cycle for up to 6 cycles

Regimen variant #2, indefinite

Study Years of enrollment Evidence
Nagao et al. 2005 2001-2004 Pilot, <20 pts

Chemotherapy

Supportive medications

21-day cycles

References

  1. 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
  2. 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. link to original article PubMed

Carboplatin & Paclitaxel (CP)

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TC: Taxol (Paclitaxel) & Carboplatin

Regimen

Study Years of enrollment Evidence Comparator Comparative Efficacy
Pectasides et al. 2009a NR Phase II
Kitagawa et al. 2015 (JCOG0505) 2006-2009 Phase III (E-switch-ic) Cisplatin & Paclitaxel Non-inferior OS

Note: Pectasides et al. 2009a allowed the regimen to be given up to 9 cycles.

Chemotherapy

21-day cycle for 6 cycles

References

  1. 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
  2. JCOG0505: Kitagawa R, Katsumata N, Shibata T, Kamura T, Kasamatsu T, Nakanishi T, Nishimura S, Ushijima K, Takano M, Satoh T, Yoshikawa H. Paclitaxel plus carboplatin versus paclitaxel plus cisplatin in metastatic or recurrent cervical cancer: the open-label randomized phase III trial JCOG0505. J Clin Oncol. 2015 Jul 1;33(19):2129-35. Epub 2015 Mar 2. link to original article contains verified protocol PubMed NCT00295789

Cisplatin monotherapy

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Regimen

Study Years of enrollment Evidence Comparator Comparative Efficacy
Thigpen et al. 1979a NR in abstract Phase II
Bonomi et al. 1985 (GOG 43) 1978-1982 Phase III (C) 1. Cisplatin; higher dose
2. Cisplatin; higher dose, split doses 		Did not meet primary endpoint of ORR
Thigpen et al. 1989 (GOG 64) 1982-1985 Phase III (C) Cisplatin; CI Did not meet primary efficacy endpoints
Omura et al. 1997 (GOG 110) 1990-1994 Phase III (C) Cisplatin & Ifosfamide Inferior PFS
Cisplatin & Mitolactol Did not meet primary endpoint of ORR
Vermorken et al. 2001 1986-1991 Phase III (C) BEMP Did not meet primary endpoint of ORR
Moore et al. 2004 (GOG 169) 1997-1999 Phase III (C) Cisplatin & Paclitaxel Inferior PFS
Long et al. 2005 (GOG 179) 1999-2002 Phase III (C) 1. Cisplatin & Topotecan Seems to have inferior OS
2. MVAC Not reported
Aoki et al. 2018 (Taiho 10020380) 2008-2011 Phase III (C) Cisplatin & S-1 Did not meet primary endpoint of OS

Note: to our knowledge, this regimen was not tested as an experimental arm in an RCT prior to becoming a standard comparator arm.

Chemotherapy

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

References

  1. Thigpen T, Shingleton H, Homesley H, LaGasse L, Blessing J; Gynecologic Oncology Group. cis-Dichlorodiammineplatinum(II) in the treatment of gynecologic malignancies: phase II trials by the Gynecologic Oncology Group. Cancer Treat Rep. 1979 Sep-Oct;63(9-10):1549-55. PubMed
  2. GOG 43: Bonomi P, Blessing JA, Stehman FB, DiSaia PJ, Walton L, Major FJ. Randomized trial of three cisplatin dose schedules in squamous-cell carcinoma of the cervix: a Gynecologic Oncology Group study. J Clin Oncol. 1985 Aug;3(8):1079-85. link to original article PubMed
  3. GOG 64: Thigpen JT, Blessing JA, DiSaia PJ, Fowler WC Jr, Hatch KD. A randomized comparison of a rapid versus prolonged (24 hr) infusion of cisplatin in therapy of squamous cell carcinoma of the uterine cervix: a Gynecologic Oncology Group study. Gynecol Oncol. 1989 Feb;32(2):198-202. link to original article contains protocol PubMed
  4. GOG 110: Omura GA, Blessing JA, Vaccarello L, Berman ML, Clarke-Pearson DL, Mutch DG, Anderson B. Randomized trial of cisplatin versus cisplatin plus mitolactol versus cisplatin plus ifosfamide in advanced squamous carcinoma of the cervix: a Gynecologic Oncology Group study. J Clin Oncol. 1997 Jan;15(1):165-71. link to original article contains protocol PubMed
  5. Vermorken JB, Zanetta G, De Oliveira CF, van der Burg ME, Lacave AJ, Teodorovic I, Boes GH, Colombo N; EORTC Gynecological Cancer Cooperative Group. Randomized phase III trial of bleomycin, vindesine, mitomycin-C, and cisplatin (BEMP) versus cisplatin (P) in disseminated squamous-cell carcinoma of the uterine cervix: an EORTC Gynecological Cancer Cooperative Group study. Ann Oncol. 2001 Jul;12(7):967-74. link to original article PubMed
  6. GOG 169: 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
  7. GOG 179: Long HJ 3rd, Bundy BN, Grendys EC Jr, Benda JA, McMeekin DS, Sorosky J, Miller DS, Eaton LA, Fiorica JV; Gynecologic Oncology Group. 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 NCT00003945
  8. Taiho 10020380: Aoki Y, Ochiai K, Lim S, Aoki D, Kamiura S, Lin H, Katsumata N, Cha SD, Kim JH, Kim BG, Hirashima Y, Fujiwara K, Kim YT, Kim SM, Chung HH, Chang TC, Kamura T, Takizawa K, Takeuchi M, Kang SB. Phase III study of cisplatin with or without S-1 in patients with stage IVB, recurrent, or persistent cervical cancer. Br J Cancer. 2018 Aug;119(5):530-537. Epub 2018 Aug 3. link to original article contains protocol PubMed NCT00770874

Cisplatin & Gemcitabine (GC)

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GC: Gemcitabine, Cisplatin

Regimen

Study Years of enrollment Evidence Comparator Comparative Efficacy
Monk et al. 2009 (GOG 204) 2003-2007 Phase III (E-switch-ic) 1. Cisplatin & Paclitaxel Seems to have inferior PFS
2. Cisplatin & Topotecan Did not meet primary endpoint of OS
3. Cisplatin & Vinorelbine Did not meet primary endpoint of OS

Chemotherapy

21-day cycles

References

  1. GOG 204: 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 link to PMC article PubMed NCT00064077

Cisplatin & Ifosfamide

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Regimen

Study Years of enrollment Evidence Comparator Comparative Efficacy
Omura et al. 1997 (GOG 110) 1990-1994 Phase III (E-esc) Cisplatin Superior PFS
Cisplatin & Mitolactol Not reported
Bloss et al. 2002 (GOG 149) 1994-1997 Phase III (C) CIB Did not meet primary endpoint of ORR

Chemotherapy

References

  1. GOG 110: Omura GA, Blessing JA, Vaccarello L, Berman ML, Clarke-Pearson DL, Mutch DG, Anderson B. Randomized trial of cisplatin versus cisplatin plus mitolactol versus cisplatin plus ifosfamide in advanced squamous carcinoma of the cervix: a Gynecologic Oncology Group study. J Clin Oncol. 1997 Jan;15(1):165-71. link to original article contains protocol PubMed
  2. GOG 149: Bloss JD, Blessing JA, Behrens BC, Mannel RS, Rader JS, Sood AK, Markman M, Benda J. Randomized trial of cisplatin and ifosfamide with or without bleomycin in squamous carcinoma of the cervix: a Gynecologic Oncology Group study. J Clin Oncol. 2002 Apr 1;20(7):1832-7. link to original article PubMed

Cisplatin & Mitomycin

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Regimen

Study Years of enrollment Evidence Efficacy
Wagenaar et al. 2001 NR in abstract Phase II ORR: 42% (95% CI: 26-61%)

Chemotherapy

Supportive medications

28-day cycle for 9 cycles

References

  1. 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; EORTC Gynecological Cancer Group. Phase II study of mitomycin-C and cisplatin in disseminated, squamous cell carcinoma of the uterine cervix: a European Organisation 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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PC: Paclitaxel & Cisplatin
CP: Cisplatin & Paclitaxel
TP: Taxol (Paclitaxel) & Platinol (Cisplatin)

Regimen variant #1, 50/135, 3 hr paclitaxel

Study Years of enrollment Evidence Comparator Comparative Efficacy
Tewari et al. 2014 (GOG 240) 2009-2012 Phase III (C) 1. Cisplatin, Paclitaxel, Bevacizumab Seems to have inferior OS
2. Paclitaxel & Topotecan Did not meet primary endpoint of OS
3. Paclitaxel, Topotecan, Bevacizumab Not reported

Chemotherapy

21-day cycles until CR or indefinitely

Regimen variant #2, 50/135, CI paclitaxel

Study Years of enrollment Evidence Comparator Comparative Efficacy
Moore et al. 2004 (GOG 169) 1997-1999 Phase III (E-esc) Cisplatin Superior PFS
Monk et al. 2009 (GOG 204) 2003-2007 Phase III (C) 1. Cisplatin & Gemcitabine Seems to have superior PFS
2. Cisplatin & Topotecan Did not meet primary endpoint of OS
3. Cisplatin & Vinorelbine Might have superior PFS
Kitagawa et al. 2015 (JCOG0505) 2006-2009 Phase III (C) Carboplatin & Paclitaxel Non-inferior OS

Note: patients in JCOG0505 received a maximum of 6 cycles.

Chemotherapy

Supportive medications

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

Regimen variant #3, 50/175

Study Years of enrollment Evidence Comparator Comparative Efficacy
Tewari et al. 2014 (GOG 240) 2009-2012 Phase III (C) 1. Cisplatin, Paclitaxel, Bevacizumab Seems to have inferior OS
2. Paclitaxel & Topotecan Did not meet primary endpoint of OS
3. Paclitaxel, Topotecan, Bevacizumab Not reported

Chemotherapy

21-day cycles until CR or indefinitely

References

  1. GOG 169: 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
  2. GOG 204: 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 link to PMC article PubMed NCT00064077
  3. GOG 240: 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 link to PMC article PubMed NCT00803062
    1. Update: Tewari KS, Sill MW, Penson RT, Huang H, Ramondetta LM, Landrum LM, Oaknin A, Reid TJ, Leitao MM, Michael HE, DiSaia PJ, Copeland LJ, Creasman WT, Stehman FB, Brady MF, Burger RA, Thigpen JT, Birrer MJ, Waggoner SE, Moore DH, Look KY, Koh WJ, Monk BJ. Bevacizumab for advanced cervical cancer: final overall survival and adverse event analysis of a randomised, controlled, open-label, phase 3 trial (Gynecologic Oncology Group 240). Lancet. 2017 Oct 7;390(10103):1654-1663. Epub 2017 Jul 27. link to original article PubMed
  4. JCOG0505: Kitagawa R, Katsumata N, Shibata T, Kamura T, Kasamatsu T, Nakanishi T, Nishimura S, Ushijima K, Takano M, Satoh T, Yoshikawa H. Paclitaxel plus carboplatin versus paclitaxel plus cisplatin in metastatic or recurrent cervical cancer: the open-label randomized phase III trial JCOG0505. J Clin Oncol. 2015 Jul 1;33(19):2129-35. Epub 2015 Mar 2. link to original article contains verified protocol PubMed NCT00295789

Cisplatin, Paclitaxel, Bevacizumab

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CP+Bev: Cisplatin, Paclitaxel, Bevacizumab

ESMO-preferred (I-A, 2017)

Regimen variant #1, 135 mg/m2 paclitaxel

Study Years of enrollment Evidence Comparator Comparative Efficacy
Tewari et al. 2014 (GOG 240) 2009-2012 Phase III (E-RT-esc) 1. Cisplatin & Paclitaxel Seems to have superior OS
2. Paclitaxel & Topotecan Did not meet primary endpoint of OS1
3. Paclitaxel, Topotecan, Bevacizumab Not reported

1Reported efficacy is based on the 2017 update.

Chemotherapy

Targeted therapy

21-day cycles until CR or indefinitely

Regimen variant #2, 175 mg/m2 paclitaxel

Study Years of enrollment Evidence Comparator Comparative Efficacy
Tewari et al. 2014 (GOG 240) 2009-2012 Phase III (E-RT-esc) 1. Cisplatin & Paclitaxel Seems to have superior OS
2. Paclitaxel & Topotecan Did not meet primary endpoint of OS1
3. Paclitaxel, Topotecan, Bevacizumab Not reported

1Reported efficacy marked is based on the 2017 update.

Chemotherapy

Targeted therapy

21-day cycles until CR or indefinitely

References

  1. GOG 240: 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 link to PMC article PubMed NCT00803062
    1. Update: Tewari KS, Sill MW, Penson RT, Huang H, Ramondetta LM, Landrum LM, Oaknin A, Reid TJ, Leitao MM, Michael HE, DiSaia PJ, Copeland LJ, Creasman WT, Stehman FB, Brady MF, Burger RA, Thigpen JT, Birrer MJ, Waggoner SE, Moore DH, Look KY, Koh WJ, Monk BJ. Bevacizumab for advanced cervical cancer: final overall survival and adverse event analysis of a randomised, controlled, open-label, phase 3 trial (Gynecologic Oncology Group 240). Lancet. 2017 Oct 7;390(10103):1654-1663. Epub 2017 Jul 27. link to original article PubMed
  2. BEATcc: NCT03556839

Cisplatin & Topotecan

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TC: Topotecan & Cisplatin
CT: Cisplatin & Topotecan

Regimen

Study Years of enrollment Evidence Comparator Comparative Efficacy
Long et al. 2005 (GOG 179) 1999-2002 Phase III (E-RT-esc) 1. Cisplatin Seems to have superior OS
2. MVAC Not reported
Monk et al. 2009 (GOG 204) 2003-2007 Phase III (E-switch-ic) 1. Cisplatin & Gemcitabine Did not meet primary endpoint of OS
2. Cisplatin & Paclitaxel Did not meet primary endpoint of OS
3. Cisplatin & Vinorelbine Did not meet primary endpoint of OS
Coronel et al. 2010 (006/027/ICI) 2007-2009 Phase III (C) CT + HV Seems to have inferior PFS

Chemotherapy

21-day cycle for up to 6 cycles

References

  1. GOG 179: Long HJ 3rd, Bundy BN, Grendys EC Jr, Benda JA, McMeekin DS, Sorosky J, Miller DS, Eaton LA, Fiorica JV; Gynecologic Oncology Group. 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 NCT00003945
  2. GOG 204: 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 link to PMC article PubMed NCT00064077
  3. 006/027/ICI: Coronel J, Cetina L, Pacheco I, Trejo-Becerril C, González-Fierro A, de la Cruz-Hernandez E, Perez-Cardenas E, Taja-Chayeb L, Arias-Bofill D, Candelaria M, Vidal S, Dueñas-González A. A double-blind, placebo-controlled, randomized phase III trial of chemotherapy plus epigenetic therapy with hydralazine valproate for advanced cervical cancer: preliminary results. Med Oncol. 2011 Dec;28 Suppl 1:S540-6. Epub 2010 Oct 8. link to original article contains verified protocol PubMed NCT00532818

Cisplatin & Vinorelbine

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VC: Vinorelbine, Cisplatin

Regimen

Study Years of enrollment Evidence Comparator Comparative Efficacy
Monk et al. 2009 (GOG 204) 2003-2007 Phase III (E-switch-ic) 1. Cisplatin & Gemcitabine Did not meet primary endpoint of OS
2. Cisplatin & Paclitaxel Might have inferior PFS
3. Cisplatin & Topotecan Did not meet primary endpoint of OS

Chemotherapy

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

References

  1. GOG 204: 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 link to PMC article PubMed NCT00064077

Ifosfamide monotherapy

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Regimen

Study Years of enrollment Evidence
Coleman et al. 1986 NR in abstract Phase II
Sutton et al. 1993a NR in abstract Phase II
Sutton et al. 1993b NR in abstract 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

  1. Coleman RE, Harper PG, Gallagher C, Osborne R, Rankin EM, Silverstone AC, Slevin ML, Souhami RL, Tobias JS, Trask CW, Wiltshaw E. A phase II study of ifosfamide in advanced and relapsed carcinoma of the cervix. Cancer Chemother Pharmacol. 1986;18(3):280-3. link to original article PubMed
  2. Sutton GP, Blessing JA, McGuire WP, Patton T, Look KY; Gynecologic Oncology Group. 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. link to original article PubMed
  3. Sutton GP, Blessing JA, DiSaia PJ, McGuire WP; Gynecologic Oncology Group. 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

Paclitaxel monotherapy

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Regimen variant #1, 135 mg/m2

Study Years of enrollment Evidence
McGuire et al. 1996 1990 Phase II
Curtin et al. 2001 1994 Phase II

Note: this was the dosage used for patients with previous pelvic radiation.

Chemotherapy

  • Paclitaxel (Taxol) 135 mg/m2 IV continuous infusion over 24 hours, started on day 1
    • Dose could be changed to 110 or 200 mg/m2 depending on toxicity

Supportive medications

21-day cycles

Regimen variant #2, 170 mg/m2

Study Years of enrollment Evidence
McGuire et al. 1996 1990 Phase II
Curtin et al. 2001 1994 Phase II

Chemotherapy

  • Paclitaxel (Taxol) 170 mg/m2 IV continuous infusion over 24 hours, started 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

21-day cycles

Regimen variant #3, 250 mg/m2

Study Years of enrollment Evidence
Kudelka et al. 1996 NR Phase II

Chemotherapy

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

Supportive medications

21-day cycles

References

  1. McGuire WP, Blessing JA, Moore D, Lentz SS, Photopulos G; Gynecologic Oncology Group. 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
  2. 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. link to original article PubMed
  3. Curtin JP, Blessing JA, Webster KD, Rose PG, Mayer AR, Fowler WC Jr, Malfetano JH, Alvarez RD; Gynecologic Oncology Group. 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

Paclitaxel & Topotecan

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TP: Topotecan, Paclitaxel

Regimen

Study Years of enrollment Evidence Comparator Comparative Efficacy
Tewari et al. 2014 (GOG 240) 2009-2012 Phase III (C) 1. Cisplatin & Paclitaxel Did not meet primary endpoint of OS
2. Cisplatin, Paclitaxel, Bevacizumab Not reported
3. Paclitaxel, Topotecan, Bevacizumab Did not meet primary endpoint of OS1

1Reported efficacy is based on the 2017 update.
Note: per the initial report, topotecan & paclitaxel +/- bevacizumab regimens were "associated with a significantly higher risk of progression" as compared to cisplatin & paclitaxel +/- bevacizumab regimens.

Chemotherapy

21-day cycles

References

  1. GOG 240: 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 link to PMC article PubMed NCT00803062
    1. Update: Tewari KS, Sill MW, Penson RT, Huang H, Ramondetta LM, Landrum LM, Oaknin A, Reid TJ, Leitao MM, Michael HE, DiSaia PJ, Copeland LJ, Creasman WT, Stehman FB, Brady MF, Burger RA, Thigpen JT, Birrer MJ, Waggoner SE, Moore DH, Look KY, Koh WJ, Monk BJ. Bevacizumab for advanced cervical cancer: final overall survival and adverse event analysis of a randomised, controlled, open-label, phase 3 trial (Gynecologic Oncology Group 240). Lancet. 2017 Oct 7;390(10103):1654-1663. Epub 2017 Jul 27. link to original article PubMed

Paclitaxel, Topotecan, Bevacizumab

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TP+Bev: Topotecan, Paclitaxel, Bevacizumab

Regimen

Study Years of enrollment Evidence Comparator Comparative Efficacy
Tewari et al. 2014 (GOG 240) 2009-2012 Phase III (E-RT-esc) 1. Cisplatin & Paclitaxel Not reported
2. Cisplatin, Paclitaxel, Bevacizumab Not reported
3. Paclitaxel & Topotecan Did not meet primary endpoint of OS1

1Reported efficacy is based on the 2017 update.
Note: in the initial report, topotecan & paclitaxel +/- bevacizumab regimens were "associated with a significantly higher risk of progression" as compared to cisplatin & paclitaxel +/- bevacizumab regimens.

Chemotherapy

Targeted therapy

21-day cycles

References

  1. GOG 240: 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 link to PMC article PubMed NCT00803062
    1. Update: Tewari KS, Sill MW, Penson RT, Huang H, Ramondetta LM, Landrum LM, Oaknin A, Reid TJ, Leitao MM, Michael HE, DiSaia PJ, Copeland LJ, Creasman WT, Stehman FB, Brady MF, Burger RA, Thigpen JT, Birrer MJ, Waggoner SE, Moore DH, Look KY, Koh WJ, Monk BJ. Bevacizumab for advanced cervical cancer: final overall survival and adverse event analysis of a randomised, controlled, open-label, phase 3 trial (Gynecologic Oncology Group 240). Lancet. 2017 Oct 7;390(10103):1654-1663. Epub 2017 Jul 27. link to original article PubMed

Topotecan monotherapy

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Regimen variant #1, q3wk

Study Years of enrollment Evidence
Bookman et al. 2000 (GOG 127-F) NR in abstract Phase II

Chemotherapy

21-day cycles

Regimen variant #2, q4wk

Study Years of enrollment Evidence
Muderspach et al. 2001 (GOG 76-U) NR in abstract Phase II

Chemotherapy

28-day cycles

References

  1. Bookman MA, Blessing JA, Hanjani P, Herzog TJ, Andersen WA; Gynecologic Oncology Group. 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
  2. GOG 76-U: Muderspach LI, Blessing JA, Levenback C, Moore JL Jr; Gynecologic Oncology Group. A phase II study of topotecan in patients with squamous cell carcinoma of the cervix: a Gynecologic Oncology Gxroup study. Gynecol Oncol. 2001 May;81(2):213-5. link to original article contains verified protocol PubMed

Vinorelbine monotherapy

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Regimen

Study Years of enrollment Evidence Efficacy
Morris et al. 1998 1993-1995 Phase II ORR: 18%

Chemotherapy

7-day cycles

References

  1. 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

Advanced or metastatic disease, subsequent lines of therapy

Bevacizumab monotherapy

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Regimen

Study Years of enrollment Evidence
Monk et al. 2009 (GOG 227-C) 2002-2006 Phase II

Targeted therapy

21-day cycles

References

  1. Monk BJ, Sill MW, Burger RA, Gray HJ, Buekers TE, Roman LD; Gynecologic Oncology Group. 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 link to PMC article PubMed

Cisplatin & Gemcitabine (GC)

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GC: Gemcitabine, Cisplatin

Regimen

Study Years of enrollment Evidence
Brewer et al. 2006 2001-2002 Phase II

Chemotherapy

28-day cycles

References

  1. Brewer CA, Blessing JA, Nagourney RA, McMeekin DS, Lele S, Zweizig SL; Gynecologic Oncology Group. 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

Docetaxel monotherapy

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Regimen variant #1, 36 mg/m2, 3 weeks out of 4

Study Years of enrollment Evidence
Garcia et al. 2008 NR in abstract Phase II

Chemotherapy

Supportive medications

28-day cycles

Regimen variant #2, 100 mg/m2, q3wk

Study Years of enrollment Evidence
Garcia et al. 2007 NR in abstract Phase II

Chemotherapy

21-day cycles

References

  1. Garcia AA, Blessing JA, Vaccarello L, Roman LD; Gynecologic Oncology Group. 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
  2. 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

FULV

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FULV: 5-FU & LeucoVorin (Folinic acid)

Regimen variant #1, 1850/200

Study Years of enrollment Evidence
Look et al. 1996 1990-1992 Phase II
Look et al. 1997 1993-1995 Phase II

Note: it is not entirely clear from these publications whether leucovorin is given on day 1 only, versus on days 1 to 5.

Chemotherapy

28-day cycle for 2 cycles, then 35-day cycles

Regimen variant #2, 2125/100

Study Years of enrollment Evidence
Look et al. 1992 NR in abstract Phase II

Chemotherapy

28-day cycle for 2 cycles, then 35-day cycles

References

  1. Look KY, Blessing JA, Muss HB, Partridge EE, Malfetano JH; Gynecologic Oncology Group. 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. link to original article PubMed
  2. Look KY, Blessing JA, Gallup DG, Lentz SS; Gynecologic Oncology Group. 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. link to original article contains verified protocol PubMed
  3. Look KY, Blessing JA, Valea FA, McGehee R, Manetta A, Webster KD, Andersen WA; Gynecologic Oncology Group. 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 monotherapy

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Regimen variant #1

Study Years of enrollment Evidence
Schilder et al. 2000 (GOG 127-K) NR in abstract Phase II
Schilder et al. 2005 NR in abstract Phase II

Chemotherapy

28-day cycles

Regimen variant #2

Study Years of enrollment Evidence Comparator Comparative Efficacy
(innovaTV 301) 2021-ongoing Phase III (C) Tisotumab vedotin Ongoing

Note: to our knowledge, this regimen was not tested as an experimental arm in an RCT prior to becoming a standard comparator arm. Dosing information is from CT.gov.

Chemotherapy

21-day cycles

References

  1. GOG 127-K: Schilder RJ, Blessing JA, Morgan M, Mangan CE, Rader JS; Gynecologic Oncology Group. 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
  2. Schilder RJ, Blessing J, Cohn DE; Gynecologic Oncology Group. 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
  3. innovaTV 301: NCT04697628

Irinotecan monotherapy

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Regimen variant #1

Study Years of enrollment Evidence Comparator Comparative Efficacy
(innovaTV 301) 2021-ongoing Phase III (C) Tisotumab vedotin Ongoing

Note: to our knowledge, this regimen was not tested as an experimental arm in an RCT prior to becoming a standard comparator arm. Dosing information is from CT.gov.

Chemotherapy

42-day cycles

Regimen variant #2

Study Years of enrollment Evidence Comparator Comparative Efficacy
Verschraegen et al. 1997 1993-1995 Phase II
(innovaTV 301) 2021-ongoing Phase III (C) Tisotumab vedotin Ongoing

Note: to our knowledge, this regimen was not tested as an experimental arm in an RCT prior to becoming a standard comparator arm.

Chemotherapy

Supportive medications

  • Diphenhydramine (Benadryl) 25 to 50 mg IV or PO 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 (Imodium) 4 mg PO as needed for each episode of delayed diarrhea between irinotecan infusions

42-day cycles

References

  1. 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
  2. innovaTV 301: NCT04697628

Pembrolizumab monotherapy

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Regimen

FDA-recommended dose
Study Years of enrollment Evidence
Chung et al. 2019 (KEYNOTE-158) 2016 Phase II (RT)

Immunotherapy

21-day cycle for up to 35 cycles (2 years)

References

  1. KEYNOTE-158: Chung HC, Ros W, Delord JP, Perets R, Italiano A, Shapira-Frommer R, Manzuk L, Piha-Paul SA, Xu L, Zeigenfuss S, Pruitt SK, Leary A. Efficacy and safety of pembrolizumab in previously treated advanced cervical cancer: results from the phase II KEYNOTE-158 study. J Clin Oncol. 2019 Jun 10;37(17):1470-1478. Epub 2019 Apr 3. link to original article contains protocol PubMed NCT02628067

Pemetrexed monotherapy

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Regimen variant #1

Study Years of enrollment Evidence Comparator Comparative Efficacy
(innovaTV 301) 2021-ongoing Phase III (C) Tisotumab vedotin Ongoing

Note: to our knowledge, this regimen was not tested as an experimental arm in an RCT prior to becoming a standard comparator arm. Dosing information is from CT.gov.

Chemotherapy

21-day cycles

Regimen variant #2

Study Years of enrollment Evidence
Miller et al. 2008 2004-2006 Phase II

Chemotherapy

Supportive medications

21-day cycles

References

  1. 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
  2. innovaTV 301: NCT04697628

Tisotumab vedotin monotherapy

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Regimen

FDA-recommended dose
Study Years of enrollment Evidence
Coleman et al. 2021 (innovaTV 204) 2018-2019 Phase II (RT)

Chemotherapy

21-day cycles

References

  1. innovaTV 204: Coleman RL, Lorusso D, Gennigens C, González-Martín A, Randall L, Cibula D, Lund B, Woelber L, Pignata S, Forget F, Redondo A, Vindeløv SD, Chen M, Harris JR, Smith M, Nicacio LV, Teng MSL, Laenen A, Rangwala R, Manso L, Mirza M, Monk BJ, Vergote I; innovaTV 204/GOG-3023/ENGOT-cx6 Collaborators. Efficacy and safety of tisotumab vedotin in previously treated recurrent or metastatic cervical cancer (innovaTV 204/GOG-3023/ENGOT-cx6): a multicentre, open-label, single-arm, phase 2 study. Lancet Oncol. 2021 May;22(5):609-619. Epub 2021 Apr 9. link to original article contains protocol PubMed NCT03438396

Topotecan monotherapy

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Regimen variant #1

Study Years of enrollment Evidence Comparator Comparative Efficacy
(innovaTV 301) 2021-ongoing Phase III (C) Tisotumab vedotin Ongoing

Note: to our knowledge, this regimen was not tested as an experimental arm in an RCT prior to becoming a standard comparator arm. Dosing information is from CT.gov.

Chemotherapy

21-day cycles

Regimen variant #2

Study Years of enrollment Evidence Comparator Comparative Efficacy
(innovaTV 301) 2021-ongoing Phase III (C) Tisotumab vedotin Ongoing

Note: to our knowledge, this regimen was not tested as an experimental arm in an RCT prior to becoming a standard comparator arm. Dosing information is from CT.gov.

Chemotherapy

21-day cycles

References

  1. innovaTV 301: NCT04697628

Vinorelbine monotherapy

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Regimen

Study Years of enrollment Evidence Comparator Comparative Efficacy
Muggia et al. 2004 1997-1999 Phase II ORR: 14% (95% CI 5-27%)
Muggia et al. 2005 1997-1999 Phase II ORR: 7%
(innovaTV 301) 2021-ongoing Phase III (C) Tisotumab vedotin Ongoing

Note: to our knowledge, this regimen was not tested as an experimental arm in an RCT prior to becoming a standard comparator arm.

Chemotherapy

21-day cycles

References

  1. Muggia FM, Blessing JA, Method M, Miller DS, Johnson GA, Lee RB, Menzin A; Gynecologic Oncology Group. 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
  2. Muggia FM, Blessing JA, Waggoner S, Berek JS, Monk BJ, Sorosky J, Pearl ML; Gynecologic Oncology Group. 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
  3. innovaTV 301: NCT04697628

Investigational agents

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