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2015 ; 22
(3
): 211-9
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Systemic therapy for recurrent, persistent, or metastatic cervical cancer: a
clinical practice guideline
#MMPMID26089720
Hirte H
; Kennedy EB
; Elit L
; Fung Kee Fung M
Curr Oncol
2015[Jun]; 22
(3
): 211-9
PMID26089720
show ga
BACKGROUND: Systemic therapy options are needed for women with recurrent,
metastatic, or persistent cervical cancer. This systematic review and clinical
practice guideline were developed to address that need, and to update a 2007
guideline from Cancer Care Ontario's Program in Evidence-Based Care. METHODS: The
literature between 2006 and April 2014 in the medline and embase databases, the
Cochrane Database of Systematic Reviews (Issue 4, 2014), the Cochrane Central
Register of Controlled Trials (Issue 3, 2014), relevant guideline databases, and
conference proceedings of the American Society of Clinical Oncology (2007-2013)
was searched. A working group developed draft guidelines and incorporated
comments and feedback from internal and external reviewers. RESULTS: Four phase
iii randomized controlled trials met the inclusion criteria for the review and
provided the basis for draft recommendations. Feedback was obtained from Ontario
practitioners and others abroad, which led to modifications to the draft
recommendations. Three key recommendations were developed. CONCLUSIONS: The
working group concluded that all patients should be offered the opportunity to
participate in appropriate randomized clinical trials. Cisplatin-paclitaxel,
cisplatin-vinorelbine, cisplatin-gemcitabine, and cisplatin-topotecan are
recommended combinations for this patient population. The substitution of
carboplatin for cisplatin in the foregoing combinations can also be recommended
because carboplatin is associated with fewer adverse effects and greater ease of
administration. Selection of combination chemotherapy will depend on the toxicity
profile, patient preference, and other factors. Finally, bevacizumab in
combination with cisplatin-paclitaxel or carboplatin-paclitaxel is recommended
for a specific subset of the target population as outlined in Gynecologic
Oncology Group study 0240.
free
free
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