Cervical cancer

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Chemotherapy & radiation therapy

Cisplatin (Platinol) & RT

Regimen #1 (Rose, et al. 1999 and Rose, et al. 2007)

  • Cisplatin (Platinol) 40 mg/m2 IV 4 hours before radiation therapy on days 1, 8, 15, 22, 29, 36
  • Concurrent radiation therapy:
    • Stage IIB disease: 1.7 Gy per dose x 24 fractions for a total of 40.8 Gy
    • Stage III/IVA disease: 1.7 Gy per dose x 30 fractions for a total of 51.0 Gy

6-week course of chemotherapy & radiation, then

  • Intracavitary brachytherapy 1-3 weeks after external beam radiation therapy (XRT):
    • Stage IIB disease: 40 Gy
    • Stage III/IVA 30 Gy
  • See Rose et al, 1999 & 2007 articles for additional details about radiation

Regimen #2 (Lanciano, et al. 2005)

  • Cisplatin (Platinol) 40 mg/m2 (maximum weekly dose of 70 mg) IV 4 hours before radiation therapy on days 1, 8, 15, 22, 29, 36
  • Concurrent radiation therapy at 1.8 Gy per dose x 25 fractions for a total of 45 Gy
  • Intracavitary brachytherapy:
    • EITHER high-dose rate (HDR) brachytherapy 30 Gy administered in 5 fractions, starting during week 4
    • OR low-dose rate (LDR) brachytherapy 40 Gy in 1-2 fractions (no start date specified)
  • Parametrial boost, 5.4-9.0 Gy to the involved parametrium after whole pelvis RT is complete

Regimen #3 (Keys, et al. 1999)

  • Cisplatin (Platinol) 40 mg/m2 (maximum weekly dose of 70 mg) IV 4 hours before radiation therapy on days 1, 8, 15, 22, 29, 36
  • Concurrent radiation therapy at 1.8-2.0 Gy per dose over 4.5-5 weeks for a total of 45 Gy
  • Intracavitary brachytherapy given that resulted in 30 Gy to the point 2 cm lateral and 2 cm superior to the cervical os) for a cumulative dose of 75 Gy a cumulative dose to the pelvic wall of 55 Gy

References

  1. 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 protocol PubMed
  2. 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 protocol PubMed
  3. 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 protocol PubMed
  4. 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 contains protocol PubMed

Cisplatin (Platinol), Fluorouracil (5-FU), RT

Regimen

21-day cycles x 4 cycles

  • Concurrent radiation therapy 1.7 Gy x 29 fractions for a total of 49.3 Gy during cycles 1 & 2
    • Patients with positive high common iliac lymph nodes also received 1.5 Gy x 30 fractions for a total of 45 Gy to the involved area

References

  1. 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 protocol PubMed

Cisplatin (Platinol), Fluorouracil (5-FU), Hydroxyurea (Hydrea), RT

Regimen

  • Cisplatin (Platinol) 50 mg/m2 IV on days 1 & 29, 4 hours before radiation therapy
  • Fluorouracil (5-FU) 1000 mg/m2/day IV over 96-hour continuous infusion on days 1-4 & 29-32
  • Hydroxyurea (Hydrea) 2000 mg/m2 PO twice per week, 2 hours before radiation therapy
  • Concurrent radiation therapy:
    • Stage IIB disease: 1.7 Gy per dose x 24 fractions for a total of 40.8 Gy
    • Stage III/IVA disease: 1.7 Gy per dose x 30 fractions for a total of 51.0 Gy

6-week course of chemotherapy & radiation, then

  • Intracavitary brachytherapy 1-3 weeks after external beam radiation therapy (XRT):
    • Stage IIB disease: 40 Gy
    • Stage III/IVA 30 Gy
  • See Rose et al, 1999 & 2007 articles for additional details about radiation

References

  1. 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 protocol PubMed
  2. 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 contains protocol PubMed

Neoadjuvant chemotherapy

Cisplatin (Platinol) & Paclitaxel (Taxol)

Regimen

10-day cycles x 3 cycles

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 protocol PubMed

Chemotherapy for metastatic disease

Cisplatin (Platinol)

Regimen

21-day cycles

References

  1. 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

Cisplatin (Platinol) & Gemcitabine (Gemzar)

Regimen

21-day cycles x up to 6 cycles

References

  1. 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 protocol PubMed

Cisplatin (Platinol) & Paclitaxel (Taxol)

Regimen

21-day cycles x up to 6 cycles

References

  1. 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 protocol PubMed
  2. 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 protocol PubMed

Cisplatin (Platinol) & Topotecan (Hycamtin)

Regimen

21-day cycles x up to 6 cycles

References

  1. 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 protocol PubMed
  2. 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 protocol PubMed

Cisplatin (Platinol) & Vinorelbine (Navelbine)

Regimen

21-day cycles x up to 6 cycles

References

  1. 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 protocol PubMed

Carboplatin (Paraplatin) & Docetaxel (Taxotere)

Regimen

21-day cycles x up to 6 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 PubMed

Paclitaxel (Taxol)

Regimen

  • Paclitaxel (Taxol) 170 mg/m2 (135 mg/m2 for patients who previously received pelvic radiation) IV over 24-hour continuous infusion day 1
    • Subsequent dose modifications of Paclitaxel (Taxol) to 110-200 mg/m2 per dose based on adverse effects

21-day cycles x up to 6 cycles

References

  1. 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 protocol PubMed
  2. 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 protocol PubMed

Topotecan (Hycamtin)

Regimen

21 to 28-day cycles

References

  1. 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 protocol PubMed
  2. 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 protocol PubMed

Vinorelbine (Navelbine)

Regimen

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 protocol PubMed
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