Treatment of cervical cancer in Italy: strategies and their impact on the women

Neoadjuvant chemotherapy with paclitaxel plus cisplatin before radical surgery for locally advanced cervical cancer during pregnancy: A case series and literature review

RATIONALE

Despite the development of human papillomavirus vaccines and significant improvement in cervical cancer screening over the past few years, cervical cancer remains the fourth most common cancer in women of childbearing age after breast cancer, melanoma, and thyroid cancer.

PATIENT CONCERNS

In this case report, the patients are all cervical cancer with stage IB2 and IB3 during pregnancy, the management constitutes a major medical challenge related to the impact of treatment on both maternal and fetal outcomes. Neoadjuvant chemotherapy (NACT) is an innovative option for cervical cancer patients with stage IB2 and IB3 before cesarean delivery and radical hysterectomy, and many chemotherapeutic agents are available, cisplatin plus paclitaxel yielded good maternal and fetal outcomes to the authors' knowledge.

DIAGNOSES

Masses were discovered in the cervix of 4 pregnant women with a history of vaginal bleeding. Biopsy examination of the masses revealed cervical carcinoma, which was staged in accordance with the International Federation of Gynecology and Obstetrics (i.e., FIGO) system.

INTERVENTIONS

The patients were treated with paclitaxel plus cisplatin, followed by cesarean delivery and radical hysterectomy.

OUTCOMES

The 4 patients were treated successfully, with no recurrence during follow-up periods of 14 to 56 months, and all of the children were doing well with no anomalies.

LESSONS

Although further data are required, in pregnant women with invasive cervical cancer, NACT with cisplatin plus paclitaxel followed by cesarean delivery and radical hysterectomy was a practical treatment option.

A Fifteen-Gene Classifier to Predict Neoadjuvant Chemotherapy Responses in Patients with Stage IB to IIB Squamous Cervical Cancer

Neoadjuvant chemotherapy (NACT) remains an attractive alternative for controlling locally advanced cervical cancer. However, approximately 15-34% of women do not respond to induction therapy. To develop a risk stratification tool, 56 patients with stage IB-IIB cervical cancer are included in 2 research centers from the discovery cohort. Patient-specific somatic mutations led to NACT non-responsiveness are identified by whole-exome sequencing. Next, CRISPR/Cas9-based library screenings are performed based on these genes to confirm their biological contribution to drug resistance. A 15-gene classifier is developed by generalized linear regression analysis combined with the logistic regression model. In an independent validation cohort of 102 patients, the classifier showed good predictive ability with an area under the curve of 0.80 (95% confidence interval (CI), 0.69-0.91). Furthermore, the 15-gene classifier is significantly associated with patient responsiveness to NACT in both univariate (odds ratio, 10.8; 95% CI, 3.55-32.86; p = 2.8 × 10-5) and multivariate analysis (odds ratio, 17.34; 95% CI, 4.04-74.40; p = 1.23 × 10-4) in the validation set. In conclusion, the 15-gene classifier can accurately predict the clinical response to NACT before treatment, representing a promising approach for guiding the selection of appropriate treatment strategies for locally advanced cervical cancer.

Neoadjuvant chemotherapy followed by conization in stage IB2-IIA1 cervical cancer larger than 2 cm: a pilot study

OBJECTIVE

To evaluate feasibility of neoadjuvant chemotherapy (NACT) followed by cold-knife conization (CKC) in patients with 2018 FIGO stage IB2-IIA1 cervical cancer who desired to maintain fertility.

DESIGN

Pilot study of conization after chemotherapy in stage IB2-IIA1 >2 cm cervical cancer.

SETTING

University hospital.

PATIENT(S)

From 2014 to 2018, 25 patients, <40 years of age, were enrolled.

INTERVENTIONS(S)

After laparoscopic pelvic lymph-node assessment, NACT with cisplatin/paclitaxel q21 was administered to eligible patients. Responsive patients were treated with CKC.

MAIN OUTCOME MEASURE(S)

Obstetrical outcome: pregnancy rate. Oncologic outcome.

RESULT(S)

Thirteen out of 25 patients were eligible for fertility-sparing treatment. Oncologic outcome: The clinical overall response rate was 84.5% (11 out of 13 patients). One patient achieved stable disease, was managed by radical surgery, and is still alive; another one experienced progression of disease and died after 15 months. The optimal pathologic response was 69.1%. In the setting of fertility preservation patients, the median follow-up was 37 months (range 18-76). In this group we registered one distant recurrence, 12 months after CKC, in the liver; the patient is still alive and without evidence of disease. Obstetrical outcome: Among the nine patients amenable, three tried to conceive, and two spontaneous pregnancy occurred a few months after the end of treatment, for a pregnancy rate of 66.7%.

CONCLUSION(S)

This pilot study supports the feasibility of CKC after NACT as conservative treatment in stage IB2-IIA1 cervical cancer, with oncologic outcomes similar to those reported for trachelectomy in the same stage and with potential benefits in terms of obstetrical outcomes.

CLINICAL TRIAL REGISTRATION NUMBER

NCT02323841.

Efficacy of neoadjuvant platinum-based chemotherapy during the second and third trimester of pregnancy in women with cervical cancer: an updated systematic review and meta-analysis

Purpose

To evaluate the efficacy and safety of neoadjuvant platinum-based chemotherapy during pregnancy in women with cervical cancer.

Methods

The PubMed, Embase, and Cochrane Library databases were fully searched to find eligible studies regarding platinum use during pregnancy in women with cervical cancer from January 1980 to September 2018. Data were extracted from the selected studies independently by two authors. Descriptive statistics were calculated for categorical data (frequency and percentage) and numeration data (mean and SD for normally distributed data and median and range for abnormally distributed data). Survival analyses were performed using Kaplan–Meier survival curves and log-rank tests to estimate overall survival and progression-free survival for all patients.

Results

A total of 39 studies including 88 cervical cancer patients with platinum administration during pregnancy were selected in this meta-analysis, and 64 women provided International Federation of Gynecology and Obstetrics stage information. Among the latter, 56 of 64 (87.5%) were diagnosed with early stages (I and IIA) and the remaining 8 of 64 (12.5%) had advanced stages (IIB, III, and IV). In relation to cisplatin, 86 pregnant women were identified, whereas only 2 pregnant women with carboplatin application were retrieved. Overall, 88 newborns were delivered from 84 pregnancies, including two sets of twins and one set of triplets, among which 71 neonates (71 of 88, 80.7%) were completely healthy at birth. All children were healthy at the end of follow-up (median 17 months, range 0–149.5 months), except one who was diagnosed with retroperitoneal embryonal rhabdomyosarcoma at 5 years old and one who had acute myeloid leukemia at 22 months of age. At the end of follow-up (range 4.75–156 months), 16 of 81 (19.8%) patients were diagnosed with recurrence of cervical cancer, and 11 (90%) of those died because of cancer relapse. Neither median overall survival nor median progression-free survival were reached.

Conclusion

Our results demonstrated that neoadjuvant platinum-based chemotherapy could be a favorable choice for the management of patients with cervical cancer during the second and third trimesters. To reduce the side effects of chemotherapy, cisplatin might be good to use as monotherapy in these patients.

Locally Advanced Cervical Cancer in Pregnancy: Overcoming the Challenge. A Case Series and Review of the Literature

OBJECTIVE

Cervical cancer is the most common gynecological cancer occurring in pregnancy, creating a complex situation both for patient and physician. Neoadjuvant chemotherapy is an innovative way of managing cervical cancer in pregnancy.

METHODS

In our paper, we report a retrospective case series of 4 women treated with chemotherapy for invasive cervical cancer during pregnancy in our center over the last 5 years, and we summarize the available literature and guidelines.

RESULTS

All the cases were locally advanced cervical cancers that received chemotherapy with platinum and/or taxanes. All patients showed a good response to chemotherapy and a radical surgery was performed with no additional morbidities at the cesarean delivery time in 3 of 4 cases. Three of 4 patients are alive and have a good outcome with no recurrence of disease up to date. One patient died because of recurrent disease 2 years after the first-line treatment during pregnancy. All babies are alive and well up to date (maximum follow-up, 63 months).

CONCLUSIONS

Even if there are no standardized practices in the treatment of cervical cancer in pregnancy, in our opinion, neoadjuvant chemotherapy can be a very useful strategy for patients and physicians facing the challenge.

Knowledge, attitude, and experience of cervical cancer and screening among Sub-saharan African female students in a UK University

BACKGROUND

Cervical cancer is one of the major diseases that affect women of child bearing age. Its main cause is the human papilloma virus; although, other associated factors have been evidenced to increase its risk. Pap-smear screening and vaccination which has been shown to be successful in reducing the incidence and prevalence of the disease in developed countries, has been neglected in developing countries due to lack of knowledge, misconceptions, and cultural beliefs.

MATERIALS AND METHODS

A cross-sectional study involving only female Sub-Saharan Africa (SSA) students in a UK university setting.

RESULTS

One hundred and eighty-six (42%) African female students were recruited from the 442 SSA students attending one of the major Universities in the UK. Seventy-one (38.2%) of the students were aware of cervical screening, but only 20 (10.8%) reported having knowledge of cervical cancer. A small percentage of about 26.9% (50 Students) were already part of this screening program; although, 81 (43.5%) showed willingness to participate in future screening programs. More so, it was evident that student's perception was dependent on their experience of the disease (P = 000) just as their participation in screening program was dependent on their awareness level (P ≤ 0.01).

CONCLUSION

Female African students from the SSA region have poor knowledge of the disease which influenced their attitude toward screening. More needs to be carried out to increase awareness and uptake of screening within the school environment as university setting provides a viable platform to promote healthy behavior. Résumé Contexte: Le cancer du col de l'utérus est l'une des principales maladies qui touchent les femmes en âge de procréer. Sa principale cause est le virus du papillome humain; Bien que, d'autres facteurs associés ont été mis en évidence pour augmenter son risque. Le dépistage du Pap et la vaccination, qui s'est avéré efficace pour réduire l'incidence et la prévalence de la maladie dans les pays développés, a été négligé dans les pays en développement en raison du manque de connaissances, d'idées fausses et de croyances culturelles. Matériel et Méthodes: Une étude transversale impliquant seulement des étudiantes d'Afrique subsaharienne (SSA) dans un université britannique. Résultats: Cent quatre-vingt-six (42%) étudiantes africaines ont été recrutées parmi les 442 étudiants SSA fréquentant l'une des plus grandes universités du Royaume-Uni. Soixante et onze (38,2%) des étudiants étaient au courant du dépistage du cancer du col, mais seulement 20 (10,8%) ont déclaré avoir une connaissance du cancer du col de l'utérus. Un faible pourcentage d'environ 26,9% (50 étudiants)Font déjà partie de ce programme de dépistage; 81 (43,5%) se sont montrés disposés à participer à de futurs programmes de dépistage. De plus, il était évident que la perception des étudiants dépendait de leur expérience de la maladie (P = 000), tout comme leur participation au programme de dépistage dépendait de leur niveau de sensibilisation (P ≤ 0,01).

CONCLUSION

Les étudiantes africaines de la région de l'Afrique subsaharienne connaissent mal la maladie et ont influencé leur attitude envers le dépistage. Davantage de mesures doivent être prises pour accroître la sensibilisation et l'adoption du dépistage dans l'environnement scolaire, car le cadre universitaire constitue une plate-forme viable pour promouvoir un comportement sain.

Knockdown of PLC-gamma-2 and calmodulin 1 genes sensitizes human cervical adenocarcinoma cells to doxorubicin and paclitaxel

Background

RNA interference (RNAi) is a powerful approach in functional genomics to selectively silence messenger mRNA (mRNA) expression and can be employed to rapidly develop potential novel drugs against a complex disease like cancer. However, naked siRNA being anionic is unable to cross the anionic cell membrane through passive diffusion and therefore, delivery of siRNA remains a major hurdle to overcome before the potential of siRNA technology can fully be exploited in cancer. pH-sensitive carbonate apatite has recently been developed as an efficient tool to deliver siRNA into the mammalian cells by virtue of its high affinity interaction with the siRNA and the desirable size distribution of the resulting siRNA-apatite complex for effective cellular endocytosis. Moreover, internalized siRNA was found to escape from the endosomes in a time-dependent manner and efficiently silence gene expression.

Results

Here we show that carbonate apatite-mediated delivery of siRNA against PLC-gamma-2 (PLCG2) and calmodulin 1 (CALM1) genes has led to the sensitization of a human cervical cancer cell line to doxorubicin- and paclitaxel depending on the dosage of the individual drug whereas no such enhancement in cell death was observed with cisplatin irrespective of the dosage following intracellular delivery of the siRNAs.

Conclusion

Thus, PLCG2 and CALM1 genes are two potential targets for gene knockdown in doxorubicin and paclitaxel-based chemotherapy of cervical cancer.

Excisional cone as fertility-sparing treatment in early-stage cervical cancer

OBJECTIVE

To describe a case series of early-stage cervical cancer patients treated with excisional cone instead of radical trachelectomy as fertility-sparing surgery.

DESIGN

Prospective study.

SETTING

University hospital.

PATIENT(S)

Early-stage cervical cancer (International Federation of Gynecology and Obstetrics stage IA2-IB1), age ≤ 45 years, tumor ≤ 20 mm.

INTERVENTION(S)

Cold-knife conization and laparoscopic pelvic lymphadenectomy.

MAIN OUTCOME MEASURE(S)

Recurrence and pregnancy rate.

RESULT(S)

There were 17 patients: 4 (23.5%) IA2, 13 (76.5%) IB1; 12 (70.5%) squamous cell carcinoma, 4 (23.5%) adenocarcinoma, and 1 (6%) glassy cell tumor. Four cases (23.5%) involved lymphovascular space invasion. The median number of lymph nodes removed was 18 (range 13-51). None of the patients received neoadjuvant chemotherapy, and two patients (12%) received three courses of adjuvant chemotherapy. No recurrences were observed after a median follow-up of 16 months (range 8-101 months). Two of five patients (40%) attempting to conceive had a spontaneous pregnancy and delivery.

CONCLUSION(S)

In selected and informed patients, conization and laparoscopic pelvic lymphadenectomy seems to be feasible as a fertility-sparing surgical approach.