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Żak K, Satora M, Skrabalak I, Tarkowski R, Ostrowska-Leśko M, Bobiński M. The Potential Influence of Residual or Recurrent Disease on Bevacizumab Treatment Efficacy in Ovarian Cancer: Current Evidence and Future Perspectives. Cancers (Basel) 2024; 16:1063. [PMID: 38473419 DOI: 10.3390/cancers16051063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Revised: 02/29/2024] [Accepted: 03/04/2024] [Indexed: 03/14/2024] Open
Abstract
There were high hopes for the new antiangiogenic medicament, bevacizumab, which could inhibit the creation of new blood vessels through binding to isoform A of vascular endothelial growth factor (VEGF). However, it is not only blood vessels that are responsible for tumor cell spread. During the process of tumor growth, lymphangiogenesis is mediated by other members of the VEGF family, specifically VEGF-C and VEGF-D, which act independent to bevacizumab. Therefore, based on the mechanism of bevacizumab action and the processes of angio- and lymphangiogenesis, we formed three hypotheses: (1) if the lymph nodes in primary ovarian cancers are metastatic, the outcome of bevacizumab treatment is worsened; (2) concerning the second-line treatment, bevacizumab will act in a weakened manner if recurrence occurs in lymph nodes as opposed to a local recurrence; (3) patients treated by bevacizumab are more likely to have recurrences in lymph nodes. These hypotheses raise the issue of the existing knowledge gap, which concerns the effect of bevacizumab on metastatic lymph nodes.
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Affiliation(s)
- Klaudia Żak
- Department of Medical Chemistry, Medical University of Lublin, 20-059 Lublin, Poland
| | - Małgorzata Satora
- I Chair and Department of Oncological Gynaecology and Gynaecology, Student Scientific Association, Medical University of Lublin, 20-059 Lublin, Poland
| | - Ilona Skrabalak
- I Chair and Department of Oncological Gynaecology and Gynaecology, Medical University of Lublin, 20-059 Lublin, Poland
| | - Rafał Tarkowski
- I Chair and Department of Oncological Gynaecology and Gynaecology, Medical University of Lublin, 20-059 Lublin, Poland
| | - Marta Ostrowska-Leśko
- Chair and Department of Toxicology, Medical University of Lublin, 20-090 Lublin, Poland
| | - Marcin Bobiński
- I Chair and Department of Oncological Gynaecology and Gynaecology, Medical University of Lublin, 20-059 Lublin, Poland
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Yadav R, Das PP, Sharma S, Sengupta S, Kumar D, Sagar R. Recent advancement of nanomedicine-based targeted delivery for cervical cancer treatment. Med Oncol 2023; 40:347. [PMID: 37930458 DOI: 10.1007/s12032-023-02195-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 09/11/2023] [Indexed: 11/07/2023]
Abstract
Cervical cancer is a huge worldwide health burden, impacting women in impoverished nations in particular. Traditional therapeutic approaches, such as surgery, radiation therapy, and chemotherapy, frequently result in systemic toxicity and ineffectiveness. Nanomedicine has emerged as a viable strategy for targeted delivery of therapeutic drugs to cancer cells while decreasing off-target effects and increasing treatment success in recent years. Nanomedicine for cervical cancer introduces several novel aspects that distinguish it from previous treatment options such as tailored delivery system, precision targeting, combination therapies, real-time monitoring and diverse nanocarriers to overcome the limitations of one another. This abstract presents recent advances in nanomedicine-based tailored delivery systems for the treatment of cervical cancer. Liposomes, polymeric nanoparticles, dendrimers, and carbon nanotubes have all been intensively studied for their ability to transport chemotherapeutic medicines, nucleic acids, and imaging agents to cervical cancer cells. Because of the way these nanocarriers are designed, they may cross biological barriers and preferentially aggregate at the tumor site, boosting medicine concentration and lowering negative effects on healthy tissues. Surface modification of nanocarriers with targeting ligands like antibodies, peptides, or aptamers improves specificity for cancer cells by identifying overexpressed receptors or antigens on the tumor surface. Furthermore, nanomedicine-based techniques have made it possible to co-deliver numerous therapeutic drugs, allowing for synergistic effects and overcoming drug resistance. In preclinical and clinical investigations, combination treatments comprising chemotherapeutic medicines, gene therapy, immunotherapy, and photodynamic therapy have showed encouraging results, opening up new avenues for individualized and multimodal treatment regimens. Furthermore, the inclusion of contrast agents and imaging probes into nanocarrier systems has enabled real-time monitoring and imaging of treatment response. This enables the assessment of therapy efficacy, the early diagnosis of recurrence, and the optimization of treatment regimens.
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Affiliation(s)
- Rakhi Yadav
- Glycochemistry Laboratory, School of Physical Sciences, Jawaharlal Nehru University, New Delhi, 110067, India
| | - Priyanku Pradip Das
- Department of Pharmaceutical Chemistry, School of Pharmaceutical Sciences, Shoolini University, Solan, Himachal Pradesh, 173229, India
| | - Sunil Sharma
- Glycochemistry Laboratory, School of Physical Sciences, Jawaharlal Nehru University, New Delhi, 110067, India
| | - Sounok Sengupta
- Department of Pharmacology, School of Pharmaceutical Sciences, Shoolini University, Solan, Himachal Pradesh, 173229, India
| | - Deepak Kumar
- Department of Pharmaceutical Chemistry, School of Pharmaceutical Sciences, Shoolini University, Solan, Himachal Pradesh, 173229, India.
| | - Ram Sagar
- Glycochemistry Laboratory, School of Physical Sciences, Jawaharlal Nehru University, New Delhi, 110067, India.
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Abstract
Most colorectal cancers (CRC) are associated with activated Wnt signaling, making it the fourth most prevalent type of cancer globally. To function properly, the Wnt signaling pathway requires secreted glycoproteins known as Wnt ligands (Wnts). Humans have 19 Wnts, which suggest a complicated signaling and biological process, and we still know little about their functions in developing CRC. This review aims to describe the canonical Wnt signaling in CRC, particularly the Wnt3a expression pattern, and their association with the angiogenesis and progression of CRC. This review also sheds light on the inhibition of Wnt3a signaling in CRC. Despite some obstacles, a thorough understanding of Wnts is essential for effectively managing CRC.
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Ding H, Zhang J, Zhang F, Xu Y, Yu Y, Liang W, Li Q. Effectiveness of combination therapy with ISA101 vaccine for the treatment of human papillomavirus-induced cervical cancer. Front Oncol 2022; 12:990877. [PMID: 36300095 PMCID: PMC9589033 DOI: 10.3389/fonc.2022.990877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 09/16/2022] [Indexed: 12/24/2022] Open
Abstract
Cervical cancer is one of the women-associated tumors that affects numerous people yearly. It is the fourth most common malignancy in women worldwide. Following early diagnosis, this cancer can be cured mainly by traditional methods such as surgery, tumor resection, and chemotherapy; nonetheless, it becomes more challenging to treat in advanced and metastatic stages. With the advent of novel treatments such as angiogenesis inhibitors or immuno-checkpoint blockers in recent years, the survival rate of patients with advanced cervical cancer has significantly increased. However, it has not yet reached a satisfactory level. It has been revealed that human papillomavirus (HPV) infection is responsible for more than 90% of cervical cancer cases. However, evidence revealed that monotherapy with anti-HPV vaccines such as ISA101 could not affect tumor growth and progression in patients with HPV-induced cervical cancer. Therefore, combining ISA101 and immune checkpoint blockers or other immunotherapeutic approaches may be more robust and effective than monotherapy with ISA101 or immune checkpoint blockers for treating cervical cancer. This review summarizes the ISA101 properties, advantages and disadvantages. Furthermore, various conducted combination therapies with ISA101 and the effectiveness and challenges of this treatment have been discussed.
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Affiliation(s)
- Haigang Ding
- Department of Gynecology, Shaoxing Maternity and Child Health Care Hospital, Shaoxing, China
- Obstetrics and Gynecology Hospital of Shaoxing University, Shaoxing, China
| | - Juan Zhang
- Department of Gynecology, Shaoxing Maternity and Child Health Care Hospital, Shaoxing, China
- Obstetrics and Gynecology Hospital of Shaoxing University, Shaoxing, China
| | - Feng Zhang
- Department of Gynecology, Shaoxing Maternity and Child Health Care Hospital, Shaoxing, China
- Obstetrics and Gynecology Hospital of Shaoxing University, Shaoxing, China
| | - Yan Xu
- Intensive Care Unit, Zhoushan Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medical University, Zhoushan, China
| | - Yijun Yu
- Medical Research Center, Zhoushan Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medical University, Zhoushan, China
| | - Wenqing Liang
- Medical Research Center, Zhoushan Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medical University, Zhoushan, China
- *Correspondence: Qingping Li, ; Wenqing Liang,
| | - Qingping Li
- Medical Research Center, Zhoushan Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medical University, Zhoushan, China
- *Correspondence: Qingping Li, ; Wenqing Liang,
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He Y, Wang J, Xie S, Xue Q. Efficacy of Bevacizumab Combined with Pemetrexed in the Treatment of Recurrent and Metastatic Cervical Cancer. Front Surg 2022; 9:908101. [PMID: 35651677 PMCID: PMC9149275 DOI: 10.3389/fsurg.2022.908101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 04/27/2022] [Indexed: 11/13/2022] Open
Abstract
Background To investigate the efficacy and safety of bevacizumab combined with pemetrexed in the treatment of recurrent and metastatic cervical cancer. Methods Clinical data of 65 patients with recurrent and metastatic cervical cancer who were admitted to our hospital were collected for retrospective analysis. All patients were administered with bevacizumab combined with pemetrexed for 4–6 cycles (21 days as 1 cycle). The short-term clinical efficacy and adverse reactions were compared between the two groups. In addition, the survival status of patients was followed up and recorded. Results At least 4 cycles of chemotherapy were given to the 65 patients. There were 0 cases of complete response (CR), 14 cases of partial response (PR), 36 cases of stable disease (SD) and 15 cases of progressive disease (PD). The objective response rate (ORR) and the disease control rate (DCR) were 21.5% (14/65) and 76.9% (50/65), respectively. DCR was superior in patients with squamous cell carcinoma to that in those with adenocarcinoma (p = 0.039), but no statistically significant difference was found in ORR. Patients with extra-pelvic metastatic lesions had a better efficacy than those with intra-pelvic metastatic lesions, but the difference was not statistically significant (p > 0.05). The post-treatment adverse reactions mainly involved fatigue, nausea and vomiting, bleeding, leukopenia, anemia, thrombocytopenia, transaminase elevation, hypertension, proteinuria and neurotoxicity, most of which were grade I–II that ameliorated after symptomatic therapy. Grade III adverse reactions mainly included pain in 5 cases (7.7%), leukopenia in 17 cases (26.2%), anemia in 22 cases (33.8%), thrombocytopenia in 6 cases (9.2%), hypertension in 5 cases (7.7%) and neurotoxicity in 7 cases (10.8%). The follow-up results manifested that median overall survival (OS) and median progression-free survival (PFS) were 10.6 months and 6.6 months, respectively. Conclusion Bevacizumab combined with pemetrexed exhibits certain efficacy in the treatment of recurrent and metastatic cervical cancer, with tolerable adverse reactions. Therefore, this therapeutic option deserves clinical popularization and application.
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Affiliation(s)
- Ying He
- Department of Gynecology, The First Affiliated Hospital of Hebei North University, Zhangjiakou, China
| | - Jing Wang
- Department of Gynecology, The First Affiliated Hospital of Hebei North University, Zhangjiakou, China
| | - Shuangshuang Xie
- Department of Gynecology, The First Affiliated Hospital of Hebei North University, Zhangjiakou, China
| | - Qianlong Xue
- Department of Emergency, The First Affiliated Hospital of Hebei North University, Zhangjiakou, China
- Correspondence: Qianlong Xue
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Itashiki Y, Harada K, Takenawa T, Ferdous T, Ueyama Y, Mishima K. Antitumor effects of bevacizumab in combination with fluoropyrimidine drugs on human oral squamous cell carcinoma. Oncol Lett 2021; 22:730. [PMID: 34429770 PMCID: PMC8371954 DOI: 10.3892/ol.2021.12991] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 01/05/2021] [Indexed: 01/13/2023] Open
Abstract
Vascular endothelial growth factor (VEGF) serves an important role in new blood vessel formation or angiogenesis, which is a critical event in tumor growth and metastasis. Bevacizumab is a humanized monoclonal antibody against VEGF-A, whereas S-1 is a fluoropyrimidine antineoplastic agent that induces apoptosis in various types of cancer cells. The present study evaluated the antitumor effects of bevacizumab in combination with 5-fluorouracil (5-FU) or S-1 against oral squamous cell carcinoma (OSCC) in vitro and in vivo. Two human OSCC cell lines were used, namely the high VEGF-A-expressing HSC-2 cells and the low VEGF-A-expressing SAS cells. MTT assay was used to evaluate the effect of bevacizumab and/or 5-FU against HSC-2 and SAS cell proliferation. Additionally, the antitumor effect of bevacizumab was evaluated alone and in combination with S-1 against HSC-2 tumors in nude mice. S-1 (6.9 mg/kg/day) was administered orally every day for 3 weeks, and bevacizumab (5 ml/kg/day) was injected intraperitoneally twice per week for 3 weeks. Apoptotic cells in mouse tumors were detected using the TUNEL method, and cell proliferation and microvessel density (MVD) were determined by immunohistochemical staining of Ki-67 and CD31, respectively. Bevacizumab alone did not inhibit OSCC cell proliferation in vitro, and did not exhibit any synergistic inhibitory effect in combination with 5-FU in vitro. However, combined bevacizumab and S-1 therapy exerted synergistic and significant antitumor effects in vivo on HSC-2 tumor xenografts, and induced apoptosis in tumor cells. Furthermore, this combination therapy led to decreased MVD and cell proliferative abilities, as well as increased apoptosis in residual tumors. The present findings suggested that the bevacizumab plus S-1 combination therapy may exert antitumor effects in high VEGF-A-expressing OSCC cells.
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Affiliation(s)
- Yasutaka Itashiki
- Department of Oral and Maxillofacial Surgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi 755-8505, Japan.,Department of Dentistry and Oral Surgery, National Hospital Organization Kanmon Medical Center, Shimonoseki, Yamaguchi 752-8510, Japan
| | - Koji Harada
- Department of Oral and Maxillofacial Surgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi 755-8505, Japan
| | - Takanori Takenawa
- Department of Oral and Maxillofacial Surgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi 755-8505, Japan
| | - Tarannum Ferdous
- Department of Oral and Maxillofacial Surgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi 755-8505, Japan
| | - Yoshiya Ueyama
- Department of Oral and Maxillofacial Surgery, Yamaguchi University, Ube, Yamaguchi 755-8505, Japan
| | - Katsuaki Mishima
- Department of Oral and Maxillofacial Surgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi 755-8505, Japan
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Chuai Y, Rizzuto I, Zhang X, Li Y, Dai G, Otter SJ, Bharathan R, Stewart A, Wang A. Vascular endothelial growth factor (VEGF) targeting therapy for persistent, recurrent, or metastatic cervical cancer. Cochrane Database Syst Rev 2021; 3:CD013348. [PMID: 33661538 PMCID: PMC8428759 DOI: 10.1002/14651858.cd013348.pub2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Cervical cancer ranks as the fourth leading cause of death from cancer in women. Historically, women with metastatic or recurrent cervical cancer have had limited treatment options. New anti-angiogenesis therapies, such as vascular endothelial growth factor (VEGF) targeting agents, offer an alternative strategy to conventional chemotherapy; they act by inhibiting the growth of new blood vessels, thereby restricting tumour growth by blocking the blood supply. OBJECTIVES To assess the benefits and harms of VEGF targeting agents in the management of persistent, recurrent, or metastatic cervical cancer. SEARCH METHODS We performed searches of the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, online registers of clinical trials, and abstracts of scientific meetings up until 27 May 2020. SELECTION CRITERIA We examined randomised controlled trials (RCTs) that evaluated the use of VEGF targeting agents alone or in combination with conventional chemotherapy or other VEGF targeting agents. DATA COLLECTION AND ANALYSIS Three review authors independently screened the results of search strategies, extracted data, assessed risk of bias, and analysed data according to the standard methods expected by Cochrane. The certainty of evidence was assessed via the GRADE approach. MAIN RESULTS A total of 1634 records were identified. From these, we identified four studies with a total of 808 participants for inclusion. We also identified two studies that were awaiting classification and nine ongoing studies. Bevacizumab plus chemotherapy versus chemotherapy Treatment with bevacizumab plus chemotherapy may result in lower risk of death compared to chemotherapy alone (hazard ratio (HR) 0.77, 95% confidence interval (CI) 0.62 to 0.95; 1 study, 452 participants; low-certainty evidence). However, there are probably more specific adverse events when compared to chemotherapy alone, including gastrointestinal perforations or fistulae (risk ratio (RR) 18.00, 95% CI 2.42 to 133.67; 1 study, 440 participants; moderate-certainty evidence); serious thromboembolic events (RR 4.5, 95% CI 1.55 to 13.08; 1 study, 440 participants; moderate-certainty evidence); and hypertension (RR 13.75, 95% CI 5.07 to 37.29; 1 study, 440 participants; moderate-certainty evidence). There may also be a higher incidence of serious haemorrhage (RR 5.00, 95% CI 1.11 to 22.56; 1 study, 440 participants; low-certainty evidence). In addition, the incidence of serious adverse events is probably higher (RR 1.44, 95% CI 1.16 to 1.79; 1 study, 439 participants; moderate-certainty evidence). The incremental cost-effectiveness ratio was USD 295,164 per quality-adjusted life-year (1 study, 452 participants; low-certainty evidence). Cediranib plus chemotherapy versus chemotherapy Treatment with cediranib plus chemotherapy may or may not result in similar risk of death when compared to chemotherapy alone (HR 0.94, 95% CI 0.53 to 1.65; 1 study, 69 participants; low-certainty evidence). We found very uncertain results for the incidences of specific adverse events, including gastrointestinal perforations or fistulae (RR 3.27, 95% CI 0.14 to 77.57; 1 study, 67 participants; very low-certainty evidence); serious haemorrhage (RR 5.45, 95% CI 0.27 to 109.49; 1 study, 67 participants; very low-certainty evidence); serious thromboembolic events (RR 3.41, 95% CI 0.14 to 80.59; 1 study, 60 participants; very low-certainty evidence); and serious hypertension (RR 0.36, 95% CI 0.02 to 8.62; 1 study, 67 participants; very low-certainty evidence). In addition, there may or may not be a similar incidence of serious adverse events compared to chemotherapy alone (RR 1.15, 95% CI 0.75 to 1.78; 1 study, 67 participants; low-certainty evidence). Apatinib plus chemotherapy or chemotherapy/brachytherapy versus chemotherapy or chemotherapy/brachytherapy Treatment with apatinib plus chemotherapy or chemotherapy/brachytherapy may or may not result in similar risk of death compared to chemotherapy alone or chemotherapy/brachytherapy alone (HR 0.90, 95% CI 0.51 to 1.60; 1 study, 52 participants; low-certainty evidence). However, hypertension events may occur at a higher incidence as compared to chemotherapy alone or chemotherapy/brachytherapy alone (RR 5.14, 95% CI 1.28 to 20.73; 1 study, 52 participants; low-certainty evidence). Pazopanib plus lapatinib versus lapatinib Treatment with pazopanib plus lapatinib may result in higher risk of death compared to lapatinib alone (HR 2.71, 95% CI 1.16 to 6.31; 1 study, 117 participants; low-certainty evidence). We found very uncertain results for the incidences of specific adverse events, including gastrointestinal perforations or fistulae (RR 2.00, 95% CI 0.19 to 21.59; 1 study, 152 participants; very low-certainty evidence); haemorrhage (RR 2.00, 95% CI 0.72 to 5.58; 1 study, 152 participants; very low-certainty evidence); and thromboembolic events (RR 3.00, 95% CI 0.12 to 72.50; 1 study, 152 participants; very low-certainty evidence). In addition, the incidence of hypertension events is probably higher (RR 12.00, 95% CI 2.94 to 49.01; 1 study, 152 participants; moderate-certainty evidence). There may or may not be a similar incidence of serious adverse events as compared to lapatinib alone (RR 1.45, 95% CI 0.94 to 2.26; 1 study, 152 participants; low-certainty evidence). Pazopanib versus lapatinib Treatment with pazopanib may or may not result in similar risk of death as compared to lapatinib (HR 0.96, 95% CI 0.67 to 1.38; 1 study, 152 participants; low-certainty evidence). We found very uncertain results for the incidences of specific adverse events, including gastrointestinal perforations or fistulae (RR 1.03, 95% CI 0.07 to 16.12; 1 study, 150 participants; very low-certainty evidence); haemorrhage (RR 1.03, 95% CI 0.31 to 3.40; 1 study, 150 participants; very low-certainty evidence); and thromboembolic events (RR 3.08, 95% CI 0.13 to 74.42; 1 study, 150 participants; very low-certainty evidence). In addition, the incidence of hypertension events is probably higher (RR 11.81, 95% CI 2.89 to 48.33; 1 study, 150 participants; moderate-certainty evidence). The risk of serious adverse events may or may not be similar as compared to lapatinib (RR 1.31, 95% CI 0.83 to 2.07; 1 study, 150 participants; low-certainty evidence). AUTHORS' CONCLUSIONS We found low-certainty evidence in favour of the use of bevacizumab plus chemotherapy. However, bevacizumab probably increases specific adverse events (gastrointestinal perforations or fistulae, thromboembolic events, hypertension) and serious adverse events. We found low-certainty evidence that does not support the use of cediranib plus chemotherapy, apatinib plus chemotherapy, apatinib plus chemotherapy/brachytherapy, or pazopanib monotherapy. We found low-certainty evidence suggesting that pazopanib plus lapatinib worsens outcomes. The VEGF inhibitors apatinib and pazopanib may increase the probability of hypertension events.
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Affiliation(s)
- Yunhai Chuai
- Department of Obstetrics and Gynaecology, Sixth Medical Centre, Chinese PLA General Hospital, Beijing, China
- Chinese PLA General Hospital, Medical School of Chinese PLA, Beijing, China
| | - Ivana Rizzuto
- Department of Gynaecological Oncology, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Xia Zhang
- Chinese PLA General Hospital, Medical School of Chinese PLA, Beijing, China
- Department of Oncology, Fifth Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Ying Li
- Chinese PLA General Hospital, Medical School of Chinese PLA, Beijing, China
- Department of Oncology, Fifth Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Guanghai Dai
- Chinese PLA General Hospital, Medical School of Chinese PLA, Beijing, China
- Department of Oncology, Fifth Medical Centre, Chinese PLA General Hospital, Beijing, China
| | | | - Rasiah Bharathan
- Department of Gynaecological Oncology, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Leicester, UK
| | | | - Aiming Wang
- Department of Obstetrics and Gynaecology, Sixth Medical Centre, Chinese PLA General Hospital, Beijing, China
- Chinese PLA General Hospital, Medical School of Chinese PLA, Beijing, China
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Tomao F, Caruso G, Musacchio L, Di Donato V, Petrella MC, Verrico M, Tomao S, Benedetti Panici P, Muzii L, Palaia I. Capecitabine in treating patients with advanced, persistent, or recurrent cervical cancer: an active and safe option? Expert Opin Drug Saf 2021; 20:641-650. [PMID: 33555963 DOI: 10.1080/14740338.2021.1887850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Introduction: Advanced, persistent or recurrent cervical cancer in patients not amenable to curative surgery or radiotherapy predicts a dismal prognosis. Systemic chemotherapy based on paclitaxel/cisplatin ± bevacizumab is the current standard of care. However, once progression occurs, the possibility of alternative treatment options is very limited.Areas covered: The usefulness of capecitabine has been well-established against several cancer types, including head and neck, breast, and colorectal cancer. This review covers current literature evidence on the clinical efficacy and safety of capecitabine in cervical cancer treatment, either as monotherapy or combined with other agents or chemo-radiotherapy.Expert opinion: Recent clinical data, albeit scant, suggested a promising role for capecitabine both as monotherapy in patients with platinum-resistant cervical cancer and in combination with cisplatin in chemotherapy-naïve patients with metastatic or recurrent cervical cancer. In our opinion, capecitabine, especially in combination regimens, could represent a valid treatment option and further research is warranted to better understand its effectiveness in these challenging patients.
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Affiliation(s)
- Federica Tomao
- Department of Gynecologic Oncology, European Institute of Oncology (IEO) IRCCS, Milan, Italy
| | - Giuseppe Caruso
- Department of Maternal and Child Health and Urological Sciences, Policlinico "Umberto I", University of Rome "Sapienza", Rome, Italy
| | - Lucia Musacchio
- Department of Maternal and Child Health and Urological Sciences, Policlinico "Umberto I", University of Rome "Sapienza", Rome, Italy
| | - Violante Di Donato
- Department of Maternal and Child Health and Urological Sciences, Policlinico "Umberto I", University of Rome "Sapienza", Rome, Italy
| | | | - Monica Verrico
- Department of Medical Oncology Unit A, Policlinico Umberto I, University of Rome "Sapienza", Rome, Italy
| | - Silverio Tomao
- Department of Medical Oncology Unit A, Policlinico Umberto I, University of Rome "Sapienza", Rome, Italy
| | - Pierluigi Benedetti Panici
- Department of Maternal and Child Health and Urological Sciences, Policlinico "Umberto I", University of Rome "Sapienza", Rome, Italy
| | - Ludovico Muzii
- Department of Maternal and Child Health and Urological Sciences, Policlinico "Umberto I", University of Rome "Sapienza", Rome, Italy
| | - Innocenza Palaia
- Department of Maternal and Child Health and Urological Sciences, Policlinico "Umberto I", University of Rome "Sapienza", Rome, Italy
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Zhang K, Wang H, Wang Z, LI F, Cui Y, Ma S, Chen R, Wang Y, Guo S, Wei Y. Intensity-modulated radiation therapy (IMRT)-based concurrent chemoradiotherapy (CCRT) with Endostar in patients with pelvic locoregional recurrence of cervical cancer: Results from a hospital in the Qinghai-Tibet Plateau. Medicine (Baltimore) 2020; 99:e21966. [PMID: 33285664 PMCID: PMC7717818 DOI: 10.1097/md.0000000000021966] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The treatment of recurrent cervical cancer, especially pelvic locoregional recurrence, is very challenging for gynecologic oncologists. This study investigated the efficacy and safety of intensity-modulated radiation therapy (IMRT)-based concurrent chemoradiotherapy (CCRT) with Endostar, a novel modified recombinant human endostatin, in patients with pelvic locoregional recurrence of cervical cancer following surgical treatment.This phase 2 study was conducted between May 2018 and May 2019 at a single center in the Qinghai-Tibet Plateau and enrolled 31 patients with pelvic locoregional recurrence of cervical cancer following surgical treatment. All patients were treated with IMRT-based CCRT for 6 weeks and intravenous infusions of Endostar (15 mg/m), which were administered on days 1 to 7 of CCRT, followed by rest for 4 weeks. After resting, chemotherapy with cisplatin (70 mg/m) plus paclitaxel (135-175 mg/m) was given every 3 weeks for a total of 4 treatments.Thirty-one patients were evaluable for the primary endpoint. The mean age was 50.03 years (SD 7.72). The objective response rate was 67.74% and the disease control rate was 83.87% (48.39% achieved a complete response, 19.35% a partial response, 16.13% had disease stabilization, and 16.13% had progressive disease). The most common adverse events were nausea, vomiting, alopecia, neutropenia, and leukopenia; most events were grade 1 or 2 in intensity. Grade 3 toxicities included thrombocytopenia and neutropenia in 2 patients each, and leukopenia in 4 patients. No cases of grade 4 acute toxicity were observed.IMRT-based CCRT with Endostar infusions is effective and safe. Our results support the use of this treatment for patients with pelvic locoregional recurrence of cervical cancer following surgical treatment.
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Affiliation(s)
- Kuan Zhang
- Department of Radiation Oncology, Qinghai Red Cross Hospital
| | - Huiping Wang
- Ultrasonic Medicine, Xining Maternal and Child Health Planning Branch Family Planning Service Centre, Qinghai, China
| | - Zhenqing Wang
- Department of Radiation Oncology, Qinghai Red Cross Hospital
| | - Fuqing LI
- Department of Radiation Oncology, Qinghai Red Cross Hospital
| | - Ying Cui
- Department of Radiation Oncology, Qinghai Red Cross Hospital
| | - Shengchun Ma
- Department of Radiation Oncology, Qinghai Red Cross Hospital
| | - Rui Chen
- Department of Radiation Oncology, Qinghai Red Cross Hospital
| | - Yuhui Wang
- Department of Radiation Oncology, Qinghai Red Cross Hospital
| | - Shul Guo
- Department of Radiation Oncology, Qinghai Red Cross Hospital
| | - Ying Wei
- Department of Radiation Oncology, Qinghai Red Cross Hospital
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Ercelep Ö, Tataroğlu D, Özçelik M, Sürmeli H, Değirmenci M, İnanç M, Aliustaoğlu M, Gümüş M. Efficacy and safety of bevacizumab in Turkish patients with metastatic and recurrent cervical cancer. Turk J Obstet Gynecol 2020; 17:123-127. [PMID: 32850187 PMCID: PMC7406906 DOI: 10.4274/tjod.galenos.2020.90699] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 05/12/2020] [Indexed: 01/07/2023] Open
Abstract
Objective: To evaluate the efficacy of bevacizumab a monoclonal, antivascular endothelial growth factor antibody in combination with cytotoxic chemotherapy in Turkish patients with recurrent and metastatic cervical cancer. Materials and Methods: Data of 64 patients with metastatic or recurrent cervical cancer, receiving bevacizumab with first-line cisplatin or carboplatin and paclitaxel chemotherapy between 2013 and 2017 were retrospectively evaluated. Results: The mean age of the patients was 49 years (range, 28-68), the median follow-up time was 12 months (range, 2-53), the median progression-free survival (PFS) was eight months, and the median overall survival (OS) was 23 months. All 64 patients received a median of 6 (range, 1-12) bevacizumab and 6 (range, 2-12) chemotherapy cycles. The chemotherapy regimens used with bevacizumab were cisplatin and paclitaxel in 31 (48%) and carboplatin and paclitaxel in 33 (52%) patients. The survival in patients treated with bevacizumab and cisplatin plus paclitaxel was better-particularly in patients with no previous cisplatin-based radiosensitizer therapy-than those treated with carboplatin, paclitaxel, and bevacizumab (p=0.023). The bevacizumab dose was 7.5 mg/kg in 30 patients (47%) and 15 mg/kg in 34 patients (53%) every 21 days. No significant difference was reported in the OS and the PFS between the two groups. While the most common all-grades adverse events were nausea, neutropenia, anemia, and peripheral sensory neuropathy, the most common grade ≥3 adverse events were neutropenia, anemia, and peripheral sensory neuropathy. Conclusion: Adding bevacizumab to platinum and paclitaxel chemotherapy in a case of metastatic or recurrent cervical cancer is an effective and tolerable treatment for Turkish patients.
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Affiliation(s)
- Özlem Ercelep
- Kartal Dr. Lütfi Kırdar Training and Research Hospital, Clinic of Medical Oncology, İstanbul, Turkey
| | - Deniz Tataroğlu
- Kartal Dr. Lütfi Kırdar Training and Research Hospital, Clinic of Medical Oncology, İstanbul, Turkey
| | - Melike Özçelik
- Kartal Dr. Lütfi Kırdar Training and Research Hospital, Clinic of Medical Oncology, İstanbul, Turkey
| | - Heves Sürmeli
- Kartal Dr. Lütfi Kırdar Training and Research Hospital, Clinic of Medical Oncology, İstanbul, Turkey
| | - Mustafa Değirmenci
- University of Health Sciences Turkey, Tepecik Training and Research Hospital, Clinic of Medical Oncology, İzmir, Turkey
| | - Mevlüde İnanç
- Kayseri Training and Research Hospital, Clinic of Medical Oncology, Kayseri, Turkey
| | - Mehmet Aliustaoğlu
- Kartal Dr. Lütfi Kırdar Training and Research Hospital, Clinic of Medical Oncology, İstanbul, Turkey
| | - Mahmut Gümüş
- İstanbul Medeniyet Universtiy, Göztepe Training and Research Hospital, Clinic of Medical Oncology, İstanbul, Turkey
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11
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Rizzuto I, Otter SJ, Bharathan R, Stewart A. Vascular endothelial growth factor (VEGF) inhibitors for the treatment of metastatic and recurrent cervical cancer. Hippokratia 2020. [DOI: 10.1002/14651858.cd013605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Ivana Rizzuto
- Department of Gynaecological Oncology; Royal Brisbane and Women’s Hospital; Brisbane Australia
| | | | - Rasiah Bharathan
- Department of Gynaecological Oncology; University Hospitals of Leicester NHS Trust, Leicester General Hospital; Leicester UK
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12
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Lee N, Kim SI, Lee M, Kim HS, Kim JW, Park NH, Song YS. Bevacizumab Efficacy and Recurrence Pattern of Persistent and Metastatic Cervical Cancer. In Vivo 2019; 33:863-868. [PMID: 31028209 PMCID: PMC6559922 DOI: 10.21873/invivo.11551] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 04/04/2019] [Accepted: 04/09/2019] [Indexed: 01/15/2023]
Abstract
BACKGROUND/AIM The aim of this study was to evaluate the efficacy of bevacizumab combined with cisplatin and paclitaxel for persistent, recurrent, or metastatic cervical cancer. MATERIALS AND METHODS This is a retrospective review of medical records of patients with persistent, recurrent, or metastatic cervical cancer. RESULTS Of the 52 patients, 33 (63.5%), 7 (13.5%) and 12 (23.1%) had recurrent, persistent and metastatic disease, respectively. Twenty-seven patients (51.9%) had prior platinum exposure. Possible bevacizumab-related serious adverse events included hypertension (n=3/52, 5.8%), febrile neutropenia (n=4/52, 7.7%) and fistula (n=2/52, 3.8%). Thirty-two recurrences (61.5%) and 20 deaths (38.5%) were noted. Median progression-free and overall survival was 9.8 months and 15.3 months, respectively. Recurrence included loco-regional (17/32, 59.4%), nodal (11/32, 34.4%), distant site (10/32, 31.3%) and peritoneal seeding (6/32, 18.8%). CONCLUSION Bevacizumab with cisplatin and paclitaxel for treating persistent, recurrent or metastatic cervical cancer is feasible and well tolerated. Loco-regional recurrence was most frequent. Overall survival was worse with recurrence at >2 sites or distant metastases.
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Affiliation(s)
- Nara Lee
- Department of Obstetrics & Gynecology, CHA Gangnam Medical Center, CHA University, Seoul, Republic of Korea
| | - Se Ik Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Maria Lee
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hee Seung Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jae Weon Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Noh Hyun Park
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yong Sang Song
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
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13
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Maltese G, Lepori S, Sabatucci I, Tripodi E, Lorusso D. Capecitabine in patients with platinum-pretreated advanced or recurrent cervical carcinoma: a retrospective study. Int J Gynecol Cancer 2019; 29:272-276. [DOI: 10.1136/ijgc-2018-000085] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 11/27/2018] [Accepted: 11/29/2018] [Indexed: 11/04/2022] Open
Abstract
BackgroundCervical cancer is a common malignancy among women and, when recurring, presents a dismal prognosis. After platinum failure, second-line treatments report response rates ranging from 3–15%, a median progression-free survival of about 3 months and a median overall survival of about 5.5 months.To retrospectively evaluate the activity and safety of capecitabine in patients with advanced/recurrent cervical carcinoma.MethodsA retrospective review of medical records of recurrent cervical cancer patients, who had failed a previous platinum–paclitaxel treatment and received oral capecitabine 1250 mg/m2 twice daily continuously from day 1 to day 14 every 21 days, was performed from December 2013 to March 2018 at the Gynecologic Oncology Unit of the Fondazione IRCCS National Cancer Institute of Milan, Italy. The response rate was evaluated every three cycles according to Response Evaluation Criteria In Solid Tumors (RECIST) version 1.1 criteria. Common Terminology Criteria for Adverse Events version 4.0 were used to evaluate adverse events.ResultsWe retrospectively analyzed 35 patients with recurrent cervical carcinoma, treated with oral capecitabine. All patients had previously received and failed a combination of carboplatin plus paclitaxel as first-line therapy for advanced/recurrent disease. Median age at the first capecitabine administration was 53 years (range 27–82). All patients were evaluable for response: the overall response rate was 34.2% (2.8% complete responses and 31.4% partial responses) with a clinical benefit rate of 57% (overall response rate plus 22.8% stabilizations of disease). The most common grade 1–2 adverse events per patient were fatigue (71.3%), hand-foot syndrome (57.0%), diarrhea (31.3%), constipation (17.0%), and nausea (10.4%). Only three patients (8.5%) reported grade 3 adverse events.ConclusionsOur data suggest that oral capecitabine should be considered an active and safe treatment in patients with recurrent cervical carcinoma after platinum failure. Based on these results, we consider capecitabine as warranting further clinical evaluation.
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14
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Lin HY, Kuo WT, Hsu CW. Laparoscopic repair of bevacizumab-induced vesicovaginal fistula in metastatic colon cancer - a video vignette. Colorectal Dis 2019; 21:123. [PMID: 30447124 DOI: 10.1111/codi.14477] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Accepted: 11/07/2018] [Indexed: 02/08/2023]
Affiliation(s)
- H-Y Lin
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Gynecology and Obstetrics, Kaohsiung Veteran General Hospital, Kaohsiung, Taiwan
| | - W-T Kuo
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Surgery, Kaohsiung Veteran General Hospital, Kaohsiung, Taiwan
| | - C-W Hsu
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Surgery, Kaohsiung Veteran General Hospital, Kaohsiung, Taiwan
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15
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Chellappan DK, Leng KH, Jia LJ, Aziz NABA, Hoong WC, Qian YC, Ling FY, Wei GS, Ying T, Chellian J, Gupta G, Dua K. The role of bevacizumab on tumour angiogenesis and in the management of gynaecological cancers: A review. Biomed Pharmacother 2018; 102:1127-1144. [DOI: 10.1016/j.biopha.2018.03.061] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Revised: 03/09/2018] [Accepted: 03/11/2018] [Indexed: 02/06/2023] Open
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16
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Marquina G, Manzano A, Casado A. Targeted Agents in Cervical Cancer: Beyond Bevacizumab. Curr Oncol Rep 2018; 20:40. [DOI: 10.1007/s11912-018-0680-3] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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17
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Godoy-Ortiz A, Plata Y, Alcaide J, Galeote A, Pajares B, Saez E, Alba E, Sánchez-Muñoz A. Bevacizumab for recurrent, persistent or advanced cervical cancer: reproducibility of GOG 240 study results in "real world" patients. Clin Transl Oncol 2017; 20:922-927. [PMID: 29222647 DOI: 10.1007/s12094-017-1808-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 11/14/2017] [Indexed: 02/06/2023]
Abstract
PURPOSE Bevacizumab is the only therapeutic target approved for patients with persistent, recurrent or advanced cervical cancer from a phase III study that combined with chemotherapy; it proves a significant increase in overall survival. To retrospectively assess the efficacy and safety of bevacizumab as the first-line treatment in patients from usual clinical practice with recurrent/persistent or advanced cervical cancer. PATIENTS AND METHODS Treatment consisted of cisplatin 50 mg/m2 or carboplatin AUC 5 plus paclitaxel 175 mg/m2 for 6-8 cycles and bevacizumab 15 mg/kg every 3 weeks up to progression or unacceptable toxicity. The endpoints were progression-free survival (PFS), overall survival (OS), response rates (RR) and toxicity. RESULTS Twenty-seven patients were included from January 2014 to June 2017, with a median follow-up 10, 1 months. Eleven percent had recurrent/persistent disease and 89% had metastatic disease at diagnosis. The prior exposition to platinum was 70%. The median PFS and OS were 9, 6 and 21, 5 months, respectively. There was an increase of fistula formation (22%). All of them had pelvic and peritoneal disease at the beginning of treatment and previous treatment with chemoradiotherapy; non-incidence differences were found according to the type of platinum agent used. There were two treatment-related deaths, one from intestinal perforation and another from severe sepsis. CONCLUSION Finally, although our study does have certain limitations, we believe that it can provide useful information and encouraging evidence that the routine use of bevacizumab as part of first-line treatment of patients with advanced cervical cancer may be associated with outcomes comparable with those obtained in GOG240 study.
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Affiliation(s)
- A Godoy-Ortiz
- Medical Oncology Service, Hospitales Universitarios Regional y Virgen de la Victoria, Av. Carlos Haya s/n, 29010, Málaga, Spain.
| | - Y Plata
- Department of Oncology, Complejo Hospitalario de Jaén, Jaén, Spain
| | - J Alcaide
- Medical Oncology Service, Hospital Costa del Sol, Málaga, Marbella, Spain
| | - A Galeote
- Medical Oncology Service, Hospitales Universitarios Regional y Virgen de la Victoria, Av. Carlos Haya s/n, 29010, Málaga, Spain
| | - B Pajares
- Medical Oncology Service, Hospitales Universitarios Regional y Virgen de la Victoria, Av. Carlos Haya s/n, 29010, Málaga, Spain.,Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga, Málaga, Spain
| | - E Saez
- Medical Oncology Service, Hospitales Universitarios Regional y Virgen de la Victoria, Av. Carlos Haya s/n, 29010, Málaga, Spain
| | - E Alba
- Medical Oncology Service, Hospitales Universitarios Regional y Virgen de la Victoria, Av. Carlos Haya s/n, 29010, Málaga, Spain.,Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga, Málaga, Spain.,Centro de Investigación Biomédica en Red de Oncología, CIBERONC-ISCIII, Madrid, Spain
| | - A Sánchez-Muñoz
- Medical Oncology Service, Hospitales Universitarios Regional y Virgen de la Victoria, Av. Carlos Haya s/n, 29010, Málaga, Spain.,Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga, Málaga, Spain
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18
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Antiangiogenics and immunotherapies in cervical cancer: an update and future's view. Med Oncol 2017; 34:115. [PMID: 28477178 DOI: 10.1007/s12032-017-0972-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 04/27/2017] [Indexed: 10/19/2022]
Abstract
Despite availability of primary and secondary prevention measures, cervical cancer (CC) persists as one of the most common cancers among women around the world, and more than 70% of cases are diagnosed at advanced stages. Although significant progress has been made in the treatment of CC, around 15-61% of patients develop a recurrence in lymph nodes or distant sites within the first 2 years of completing treatment and the prognosis for these patients remains poor. During the last decades, in an attempt to improve the outcome in these patients, novel agents as combination therapy that target known dysfunctional molecular pathways have been developed with the most attention to the inhibitors of the angiogenesis process. One therapeutic target is the vascular endothelial growth factor, which has been shown to play a key role in tumor angiogenesis, not only for growth of new tissue but also in tumor proliferation. Bevacizumab is recognized as a potent antiangiogenic agent in ovarian cancer but has also demonstrated encouraging antitumor activity in recurrent CC. Moreover, other antiangiogenic agents were recently under study including: sunitinib, sorafenib, pazopanib, cediranib and nintedanib with interesting preliminary results. Moreover, over the last few years there has been increasing interest in cellular immunotherapy as a strategy to harness the immune system to fight tumors. This article focuses on recent discoveries about antiangiogenic agents and immunotherapies in the treatment of CC highlighting on future's view.
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19
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Wuertz BR, Darrah L, Wudel J, Ondrey FG. Thiazolidinediones abrogate cervical cancer growth. Exp Cell Res 2017; 353:63-71. [PMID: 28219679 DOI: 10.1016/j.yexcr.2017.02.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 02/13/2017] [Accepted: 02/15/2017] [Indexed: 11/29/2022]
Abstract
Peroxisome proliferator-activated receptor gamma (PPAR γ) is activated by thiazolidinedione drugs (TZDs) and can promote anti-cancer properties. We used three TZDs (pioglitazone, rosiglitazone, and ciglitazone) to target cervical cancer cell lines and a nude mouse animal model. Each agent increased activation of PPAR γ, as judged by a luciferase reporter gene assay in three HPV-associated cell lines (CaSki, SiHa, and HeLa cells) while decreasing cellular proliferation in a dose-dependent manner. They also promoted Oil Red O accumulation in treated cell lines and upregulated the lipid differentiation marker adipsin. Interestingly, xenograft HeLa tumors in nude mice treated with 100mg/kg/day pioglitazone exhibited decreased growth compared to control mice or mice treated with standard cervical chemotherapy. In conclusion, TZDs slow tumor cell growth in vitro and in vivo with decreases in cell proliferation and increases in PPAR γ and adipsin. These agents may be interesting treatments or treatment adjuncts for HPV-associated cancers or perhaps even precancerous conditions.
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Affiliation(s)
- Beverly R Wuertz
- Molecular Oncology Program, Department of Otolaryngology, University of Minnesota, Minneapolis, MN 55455, USA.
| | - Lindsay Darrah
- Molecular Oncology Program, Department of Otolaryngology, University of Minnesota, Minneapolis, MN 55455, USA.
| | - Justin Wudel
- Molecular Oncology Program, Department of Otolaryngology, University of Minnesota, Minneapolis, MN 55455, USA.
| | - Frank G Ondrey
- Molecular Oncology Program, Department of Otolaryngology, University of Minnesota, Minneapolis, MN 55455, USA.
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20
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Minion LE, Tewari KS. The safety and efficacy of bevacizumab in the treatment of patients with recurrent or metastatic cervical cancer. Expert Rev Anticancer Ther 2017; 17:191-198. [PMID: 27748633 DOI: 10.1080/14737140.2016.1246187] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
INTRODUCTION Bevacizumab is a recombinant humanized monoclonal antibody against vascular endothelial growth factor (VEGF). (Avastin; Genetech, Inc, San Francisco, CA) Angiogenesis is blocked by the binding of bevacizumab to VEGF, inhibiting the binding of this ligand to the VEGF receptor. On 14 August 2014 the Food and Drug Administration (FDA) approved use of bevacizumab in persistent, recurrent, or metastatic cervical cancer. Areas covered: Herein we review pharmacodynamics and kinetics, clinical data and treatment-related toxicities of bevacizumab in the treatment of metastatic, recurrent or persistent cervical cancer. Additionally, future areas of development are reviewed. Expert commentary: Anti-angiogenesis therapy with bevacizumab is central to metastatic, persistent, and recurrent cervical cancer treatment. Additional anti-angiogenesis drugs are in development. Future studies will need to establish if the addition of multiple anti-angiogenesis agents or anti-angiogenesis in combination with immunotherapy is more effective than bevacizumab with chemotherapy.
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Affiliation(s)
- Lindsey E Minion
- a The Division of Gynecologic Oncology, Department of Obstetrics & Gynecology , University of California, Irvine Medical Center , Orange , CA , USA
| | - Krishnansu S Tewari
- a The Division of Gynecologic Oncology, Department of Obstetrics & Gynecology , University of California, Irvine Medical Center , Orange , CA , USA
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21
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Bizzarri N, Ghirardi V, Alessandri F, Venturini PL, Valenzano Menada M, Rundle S, Leone Roberti Maggiore U, Ferrero S. Bevacizumab for the treatment of cervical cancer. Expert Opin Biol Ther 2016; 16:407-19. [PMID: 26796332 DOI: 10.1517/14712598.2016.1145208] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Cervical cancer is still a major cause of morbidity and mortality in women. Early stages and locally advanced cervical cancer are currently treated respectively with surgery and chemoradiation with good prognosis. Persistent, recurrent and metastatic cervical cancers have a poor prognosis. Angiogenesis has been identified as a crucial factor for cervical cancer growth. Recently, research has increasingly focused on the development of targeted therapies, such as anti-angiogenic drugs. Amongst such drugs, bevacizumab, a recombinant humanized monoclonal antibody has been the subject of extensive investigation, including its use in cervical cancer. This was recently approved for the treatment of patients with metastatic, recurrent, or persistent cervical cancer. AREAS COVERED The aim of this review is to discuss the role of bevacizumab in both locally advanced and metastatic or recurrent cervical cancer and to analyze the studies that have led to the approval of bevacizumab in cervical cancer. EXPERT OPINION The use of bevacizumab in combination with other chemotherapies in cervical cancer has been proven safe and effective, with a significant improvement in overall survival of patients with advanced cervical cancer. Combination therapy using bevacizumab has been demonstrated to increase toxicity rates but it does not impair patient's quality of life.
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Affiliation(s)
- Nicolò Bizzarri
- a Academic Unit of Obstetrics and Gynecology , IRCCS AOU San Martino - IST , Genoa , Italy.,b Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI) , University of Genoa , Genoa , Italy
| | - Valentina Ghirardi
- a Academic Unit of Obstetrics and Gynecology , IRCCS AOU San Martino - IST , Genoa , Italy.,b Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI) , University of Genoa , Genoa , Italy
| | - Franco Alessandri
- c Unit of Obstetrics and Gynecology , IRCCS AOU San Martino - IST , Genoa , Italy
| | - Pier Luigi Venturini
- a Academic Unit of Obstetrics and Gynecology , IRCCS AOU San Martino - IST , Genoa , Italy.,b Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI) , University of Genoa , Genoa , Italy
| | - Mario Valenzano Menada
- a Academic Unit of Obstetrics and Gynecology , IRCCS AOU San Martino - IST , Genoa , Italy.,b Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI) , University of Genoa , Genoa , Italy
| | - Stuart Rundle
- d Northern Gynaecological Oncology Centre , Queen Elizabeth Hospital , Gateshead , UK
| | - Umberto Leone Roberti Maggiore
- a Academic Unit of Obstetrics and Gynecology , IRCCS AOU San Martino - IST , Genoa , Italy.,b Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI) , University of Genoa , Genoa , Italy
| | - Simone Ferrero
- a Academic Unit of Obstetrics and Gynecology , IRCCS AOU San Martino - IST , Genoa , Italy.,b Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI) , University of Genoa , Genoa , Italy
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22
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Alldredge JK, Tewari KS. Clinical Trials of Antiangiogenesis Therapy in Recurrent/Persistent and Metastatic Cervical Cancer. Oncologist 2016; 21:576-85. [PMID: 27026677 DOI: 10.1634/theoncologist.2015-0393] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 12/01/2015] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Treatment options for women with metastatic, persistent, or recurrent cervical cancer are limited and thus the disease portends a poor prognosis. It is critical to understand the pathophysiology of cervical cancer to better delineate therapeutic targets. The development of antiangiogenic therapies and their subsequent analysis in rigorous therapeutic trials have redefined current management strategies and is an exciting area of current exploration. RESULTS Translational trials have furthered the understanding of molecular determinants of angiogenesis. Phase II trials have shown promising trends with developing antiangiogenic therapies. A practice-changing phase III trial has recently been published. Given the potential benefits and different toxicity spectrum compared with standard cytotoxic chemotherapy, antiangiogenic options are under active investigation for this vulnerable patient population. Emerging data are promising for other antiangiogenic-directed therapeutics, as well as cervical cancer molecular biomarkers to guide diagnosis and treatment. CONCLUSION Antiangiogenic therapies have evolved during the past 20 years and remain an exciting area of current exploration. IMPLICATIONS FOR PRACTICE Understanding of the angiogenic microenvironment has furthered understanding of tumor biology and management. Antiangiogenic therapies show promise for women with advanced cervical cancer. A review of the evolution of these biologic agents shows them to be an effective and tolerable management strategy for many patients in this vulnerable population, with exciting future potential.
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23
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Crafton SM, Salani R. Beyond Chemotherapy: An Overview and Review of Targeted Therapy in Cervical Cancer. Clin Ther 2016; 38:449-58. [PMID: 26926322 DOI: 10.1016/j.clinthera.2016.02.007] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 01/27/2016] [Accepted: 02/06/2016] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study was to provide an overview of current and up and coming targeted therapies in cervical cancer with or without chemotherapy. METHODS We reviewed the literature using search terms cervical cancer AND immunotherapy, immune therapy, vaccines, bevacizumab, anti-angiogenic therapy, and PARP inhibitors on PubMed. We included all review articles and prospective trials. We also reviewed ClinicalTrials.gov for trials in progress. FINDINGS The addition of bevacizumab has improved the overall survival of women with advanced or recurrent cervical cancer when compared with cytotoxic therapy alone. This advancement has sparked an interest in other anti-angiogenic agents. Additionally, targeted therapies, including tyrosine kinase inhibitors, immunotherapy, and vaccine therapy, are also being evaluated. Another exciting area of study is the role of poly (ADP-ribose) polymerase inhibition in cervical cancer. IMPLICATIONS Though the results are promising, the data are preliminary and additional studies evaluating the proper combination of therapy, dosing, and schedules will help inform the ideal regimen.
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Affiliation(s)
- Sarah M Crafton
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The Ohio State University Comprehensive Cancer Center, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, Ohio
| | - Ritu Salani
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The Ohio State University Comprehensive Cancer Center, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, Ohio.
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24
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Mackay HJ, Wenzel L, Mileshkin L. Nonsurgical management of cervical cancer: locally advanced, recurrent, and metastatic disease, survivorship, and beyond. Am Soc Clin Oncol Educ Book 2016:e299-309. [PMID: 25993189 DOI: 10.14694/edbook_am.2015.35.e299] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Despite the declining incidence of cervical cancer as a result of the introduction of screening programs, globally it remains a leading cause of cancer-related death in women. Outcomes for patients who are diagnosed with anything but early-stage disease remain poor. Here we examine emerging strategies to improve the treatment of locally advanced disease. We discuss emerging biologic data, which are informing our investigation of new therapeutic interventions in persistent, recurrent, and metastatic cervical cancer. We recognize the importance of interventions to improve quality of life and to prevent long-term sequelae in women undergoing treatment. Finally, and perhaps most importantly, we recognize the need for global collaboration and advocacy to improve the outcome for all women at risk of and diagnosed with this disease.
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Affiliation(s)
- Helen J Mackay
- From the Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre/Deptartment of Medicine, University of Toronto, Ontario, Canada; Department of Medicine and Public Health, University of California, Irvine, Irvine, CA; Division of Cancer Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Lari Wenzel
- From the Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre/Deptartment of Medicine, University of Toronto, Ontario, Canada; Department of Medicine and Public Health, University of California, Irvine, Irvine, CA; Division of Cancer Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Linda Mileshkin
- From the Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre/Deptartment of Medicine, University of Toronto, Ontario, Canada; Department of Medicine and Public Health, University of California, Irvine, Irvine, CA; Division of Cancer Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia
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Pfaendler KS, Tewari KS. Changing paradigms in the systemic treatment of advanced cervical cancer. Am J Obstet Gynecol 2016; 214:22-30. [PMID: 26212178 PMCID: PMC5613936 DOI: 10.1016/j.ajog.2015.07.022] [Citation(s) in RCA: 139] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 07/12/2015] [Accepted: 07/17/2015] [Indexed: 12/11/2022]
Abstract
Despite availability of primary and secondary prevention measures, cervical cancer persists as one of the most common cancers among women around the world. Although early-stage disease can be cured with radical and even fertility-sparing surgery, patients with metastatic and recurrent cervical cancer have poor prognosis with historically limited treatment options and incurable disease. Significant advances in cervical cancer treatment have emerged as the result of clinical trials that have sought to determine the best therapy to prolong overall and progression-free survival. Most recently, trials that have involved angiogenesis blockade in addition to standard chemotherapy have demonstrated improved overall and progression-free survival. This review serves to highlight pivotal trials in chemotherapy development for advanced, metastatic, and recurrent cervical cancer that includes the paradigm-shifting work that demonstrates increased overall survival with angiogenesis blockade.
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Affiliation(s)
- Krista S Pfaendler
- Division of Gynecologic Oncology, University of California, Irvine, Orange, CA
| | - Krishnansu S Tewari
- Division of Gynecologic Oncology, University of California, Irvine, Orange, CA; Division of Gynecologic Oncology, University of California, Irvine, Irvine Medical Center, University of California, Orange, CA.
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Eskander RN, Tewari KS. Development of bevacizumab in advanced cervical cancer: pharmacodynamic modeling, survival impact and toxicology. Future Oncol 2015; 11:909-22. [PMID: 25760973 DOI: 10.2217/fon.14.276] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Historically, patients with metastatic, persistent or recurrent cervical cancer had limited therapeutic options. Despite several Phase II/III clinical trials, the combination of cisplatin and paclitaxel remained the most effective chemotherapeutic regimen. In 2014, publication of Gynecologic Oncology Group 240 represented the emergence of an alternate and effective therapeutic option. This prospective, randomized, Phase III clinical trial explored the impact of adding the antiangiogenic agent bevacizumab to two separate cytotoxic chemotherapy backbones. Importantly, the study met its primary end point, showing a survival advantage of approximately 4 months without detriment in quality of life. As such, a review of bevacizumab and its application in patients with advanced-stage cervical cancer is warranted.
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Affiliation(s)
- Ramez N Eskander
- Department of Obstetrics & Gynecology, Division of Gynecologic Oncology, University of California, Irvine Medical Center, Orange, CA 92868, USA
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Fisher CM, Schefter TE. Profile of bevacizumab and its potential in the treatment of cervical cancer. Onco Targets Ther 2015; 8:3425-31. [PMID: 26640382 PMCID: PMC4657807 DOI: 10.2147/ott.s73251] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Blocking angiogenesis is an effective antitumor strategy proven in many disease sites. Anti-angiogenic therapies are fulfilling the promise of improved outcomes in cervical cancer as demonstrated in several recent trials. With its overall survival improvement in metastatic or recurrent cervical cancer, a frame shift in the management of these patients has occurred. The US Food and Drug Administration approval of bevacizumab in advanced cervical cancer has led to national guidelines, including the US National Comprehensive Cancer Network guidelines for cervical cancer, including systemic regimens containing bevacizumab as first line combination therapy. Future trials will build on this anti-angiogenesis backbone via targeting additional novel pathways and potentially leading to further improved outcomes in cervical cancer.
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Affiliation(s)
- Christine M Fisher
- Department of Radiation Oncology, University of Colorado, Denver, CO, USA
| | - Tracey E Schefter
- Department of Radiation Oncology, University of Colorado, Denver, CO, USA
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Rodriguez-Freixinos V, Mackay HJ. Breaking down the evidence for bevacizumab in advanced cervical cancer: past, present and future. GYNECOLOGIC ONCOLOGY RESEARCH AND PRACTICE 2015; 2:8. [PMID: 27231568 PMCID: PMC4881045 DOI: 10.1186/s40661-015-0015-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 09/16/2015] [Indexed: 12/15/2022]
Abstract
Despite the introduction of screening and, latterly, vaccination programs in the developed world, globally cervical cancer remains a significant health problem. For those diagnosed with advanced or recurrent disease even within resource rich communities, prognosis remains poor with an overall survival (OS) of just over 12 months. New therapeutic interventions are urgently required. Advances in our understanding of the mechanisms underlying tumor growth and the downstream effects of human papilloma virus (HPV) infection identified angiogenesis as a rational target for therapeutic intervention in cervical cancer. Anti-angiogenic agents showed promising activity in early phase clinical trials culminating in a randomized phase III study of the humanized monoclonal antibody to vascular endothelial growth factor (VEGF), bevacizumab, in combination with chemotherapy. This pivotal study, the Gynecologic Oncology Group protocol 240, met its primary endpoint demonstrating a significant improvement in OS. Bevacizumab became the first targeted agent to be granted regulatory approval by the United States Food and Drug Administration for use alongside chemotherapy in adults with persistent, recurrent or metastatic carcinoma of the cervix. This review outlines the rationale for targeting angiogenesis in cervical cancer focusing on the current indications for the use of bevacizumab in this disease and future directions.
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Affiliation(s)
- Victor Rodriguez-Freixinos
- Division of Medical Oncology and Hematology, Princess Margaret Hospital, University of Toronto, 610 University Avenue, Toronto, Ontario M5G 2 M9 Canada
| | - Helen J Mackay
- Division of Medical Oncology and Hematology, Princess Margaret Hospital, University of Toronto, 610 University Avenue, Toronto, Ontario M5G 2 M9 Canada
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Jin L, Xu ZX. Recent advances in the study of HPV-associated carcinogenesis. Virol Sin 2015; 30:101-6. [PMID: 25910482 DOI: 10.1007/s12250-015-3586-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Accepted: 04/16/2015] [Indexed: 10/23/2022] Open
Abstract
Human papillomaviruses (HPVs) cause virtually all cervical cancers, the second leading cause of death by cancer among women, as well as other anogenital cancers and a subset of head and neck cancers. Approximately half of women, who develop cervical cancer die from it. Despite the optimism that has accompanied the introduction of prophylactic vaccines to prevent some HPV infections, the relatively modest uptake of the vaccine, especially in the developing world, and the very high fraction of men and women who are already infected, means that HPV-associated disease will remain as a significant public health problem for decades. In this review, we summarize some recent findings on HPV-associated carcinogenesis, such as miRNAs in HPV-associated cancers, implication of stem cells in the biology and therapy of HPV-positive cancers, HPV vaccines, targeted therapy of cervical cancer, and drug treatment for HPV-induced intraepithelial neoplasias.
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Affiliation(s)
- Liyan Jin
- Division of Hematology and Oncology, Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, 35205, USA
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Krill LS, Tewari KS. Integration of bevacizumab with chemotherapy doublets for advanced cervical cancer. Expert Opin Pharmacother 2015; 16:675-83. [PMID: 25643984 DOI: 10.1517/14656566.2015.1010511] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Historically, treatment options were limited for women diagnosed with late-stage or recurrent cervical cancer until recently. The publication of the results of GOG240 marks the beginning of the anti-angiogenesis era in cervical cancer. This randomized controlled trial showed significant improvements in response rates, progression-free survival and overall survival when bevacizumab was added to conventional chemotherapy in patients with metastatic, recurrent, or persistent cervical cancer. Bevacizumab is the first new drug to be approved in this disease in over 8 years. It is also the first biologic agent to be approved for use in patients with a gynecologic malignancy. AREAS COVERED This review will highlight the evolution of combination chemotherapy for advanced cervical carcinoma, with particular emphasis on the recent ground-breaking research on the anti-angiogenesis therapy. EXPERT OPINION Experts believe that the discoveries surrounding angiogenesis inhibitors have changed the standard of practice for women with incurable invasive cervical cancer. We will explore the advantages and disadvantages of anti-angiogenesis therapies. Ultimately, we hope that the research summarized here will one day alter the face of this disease by offering this high-risk population a rare commodity: survivorship.
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Affiliation(s)
- Lauren S Krill
- University of California Irvine Medical Center , Orange, CA , USA
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Krill LS, Tewari KS. Exploring the therapeutic rationale for angiogenesis blockade in cervical cancer. Clin Ther 2015; 37:9-19. [PMID: 25592088 PMCID: PMC5581982 DOI: 10.1016/j.clinthera.2014.11.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Revised: 11/20/2014] [Accepted: 11/24/2014] [Indexed: 12/20/2022]
Abstract
PURPOSE This review highlights the molecular and pathologic evidence that cervical cancer is driven by angiogenesis and presents a summary of the recent clinical research in antiangiogenesis therapy for advanced cervical cancer with a focus on the use of bevacizumab. METHODS The articles chosen for this review reveal the rationale for antiangiogenesis agents in cervical cancer from 3 perspectives: pathologic, molecular, and clinical data. FINDINGS Several translational investigations have revealed that proangiogenic signaling cascades are active in cervical carcinogenesis and can be used to improve patient outcomes in advanced disease. For example, in a recently published study of patients with recurrent and metastatic cervical cancer, bevacizumab was the first targeted agent to improve overall survival in a gynecologic cancer when successfully combined with 2 different chemotherapy regimens. IMPLICATIONS Because of recent advances in screening, aggressive management of cervical intraepithelial neoplasia, and human papillomavirus vaccination, cervical cancer is preventable and curable with radical surgery plus lymphadenectomy surgery or chemoradiation plus brachytherapy if detected early. Unfortunately, for patients with metastatic or recurrent disease, effective therapeutic options are limited for this aggressive life-threatening condition. However, molecularly targeted agents have provided a critical opportunity to improve patient outcomes beyond optimizing cytotoxic chemotherapy regimens so that they may benefit from other agents or emergent therapies in the future.
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Affiliation(s)
- Lauren S Krill
- The Division of Gynecologic Oncology, University of California, Irvine Medical Center, Orange, California
| | - Krishnansu S Tewari
- The Division of Gynecologic Oncology, University of California, Irvine Medical Center, Orange, California.
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Duenas-Gonzalez A, Serrano-Olvera A, Cetina L, Coronel J. New molecular targets against cervical cancer. Int J Womens Health 2014; 6:1023-31. [PMID: 25525394 PMCID: PMC4266260 DOI: 10.2147/ijwh.s49471] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Cervical cancer is the third most commonly diagnosed cancer worldwide and the fourth leading cause of cancer death in women. Major advances but still insufficient achievements in the treatment of locally advanced and high-risk early stage patients have occurred in the last decade with the incorporation of concurrent cisplatin with radiation and, lately, gemcitabine added to cisplatin chemoradiation. Despite a number of clinical studies incorporating molecular-targeted therapy as radiosensitizers being in progress, so far, only antiangiogenic therapy with bevacizumab added to cisplatin chemoradiation has demonstrated safety and shown encouraging results in a Phase II study. In advanced disease, cisplatin doublets do not have a great impact on the natural history of the disease with median survival rates not exceeding 13 months. The first Phase III study of bevacizumab, added to cisplatin or a non-cisplatin-containing doublet, showed significant increase in both overall survival and progression-free survival. Further studies are needed before bevacizumab plus chemotherapy can be considered the standard of care for advanced disease. Characterization of the mutational landscape of cervical cancer has already been initiated, indicating that, for now, few of these targetable alterations match with available agents. Progress in both the mutational landscape knowledge and developments of novel targeted therapies may result in more effective and individualized treatments for cervical cancer. The potential efficacy of knocking down the key alterations in cervical cancer – E6 and E7 human papillomavirus oncoproteins – must not be overlooked.
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Affiliation(s)
- Alfonso Duenas-Gonzalez
- Unit of Biomedical Research in Cancer, Instituto de Investigaciones Biomedicas UNAM/Instituto Nacional de Cancerologia, Mexico City, Mexico ; ISSEMyM Cancer Center, Toluca, Mexico
| | | | - Lucely Cetina
- Division of Clinical Research, Instituto Nacional de Cancerologia, Mexico City, Mexico
| | - Jaime Coronel
- Division of Clinical Research, Instituto Nacional de Cancerologia, Mexico City, Mexico
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Tomao F, Papa A, Rossi L, Zaccarelli E, Caruso D, Zoratto F, Benedetti Panici P, Tomao S. Angiogenesis and antiangiogenic agents in cervical cancer. Onco Targets Ther 2014; 7:2237-48. [PMID: 25506227 PMCID: PMC4259513 DOI: 10.2147/ott.s68286] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Standard treatment of cervical cancer (CC) consists of surgery in the early stages and of chemoradiation in locally advanced disease. Metastatic CC has a poor prognosis and is usually treated with palliative platinum-based chemotherapy. Current chemotherapeutic regimens are associated with significant adverse effects and only limited activity, making identification of active and tolerable novel targeted agents a high priority. Angiogenesis is a complex process that plays a crucial role in the development of many types of cancer. The dominant role of angiogenesis in CC seems to be directly related to human papillomavirus-related inhibition of p53 and stabilization of hypoxia-inducible factor-1α. Both of these mechanisms are able to increase expression of vascular endothelial growth factor (VEGF). Activation of VEGF promotes endothelial cell proliferation and migration, favoring formation of new blood vessels and increasing permeability of existing blood vessels. Since bevacizumab, a recombinant humanized monoclonal antibody binding to all isoforms of VEGF, has been demonstrated to significantly improve survival in gynecologic cancer, some recent clinical research has explored the possibility of using novel therapies directed toward inhibition of angiogenesis in CC too. Here we review the main results from studies concerning the use of antiangiogenic drugs that are being investigated for the treatment of CC.
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Affiliation(s)
- Federica Tomao
- Department of Gynecology and Obstetrics, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
| | - Anselmo Papa
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Oncology Unit, ICOT, Latina, Italy
| | - Luigi Rossi
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Oncology Unit, ICOT, Latina, Italy
| | - Eleonora Zaccarelli
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Oncology Unit, ICOT, Latina, Italy
| | - Davide Caruso
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Oncology Unit, ICOT, Latina, Italy
| | - Federica Zoratto
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Oncology Unit, ICOT, Latina, Italy
| | - Pierluigi Benedetti Panici
- Department of Gynecology and Obstetrics, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
| | - Silverio Tomao
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Oncology Unit, ICOT, Latina, Italy
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Abstract
Patients with advanced stage or recurrent cervical cancer represent a population with limited chemotherapeutic options. More specifically, patients with recurrent disease have a poor salvage rate, with a 5-year survival rate of less than 10%. This year, the first prospective phase III clinical trial exploring the anti-angiogenic agent, bevacizumab, was published, meeting its primary endpoint, with a significant improvement in overall survival. As such, a review of anti-angiogenic therapy in the treatment of this disease is warranted.
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Affiliation(s)
- Ramez N Eskander
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of California Irvine Medical Center, Orange CA, USA
| | - Krishnansu S Tewari
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of California, Irvine, 101 The City Dr. South, Building 56 Room 264, 101 The City Dr., Orange, CA 92868, USA
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A phase I trial of combination trastuzumab, lapatinib, and bevacizumab in patients with advanced cancer. Invest New Drugs 2014; 33:177-86. [PMID: 25323060 DOI: 10.1007/s10637-014-0173-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Accepted: 10/07/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE Preclinical data indicate that combination HER2-directed and anti-VEGF therapy may bypass resistance to trastuzumab. A phase I trial was performed to assess safety, activity, and correlates. EXPERIMENTAL DESIGN Patients with advanced, refractory malignancy were enrolled (modified 3 + 3 design with expansions for responding tumor types). Patients received lapatinib daily for 21 days, and bevacizumab and trastuzumab every 3 weeks. Correlates included HER2 extracellular domain levels (ECD) and single nucleotide polymorphisms (SNPs). RESULTS Ninety-four patients were treated (median = four prior systemic therapies). The most common related adverse events ≥ grade 2 were diarrhea (n = 33, 35 %) and hypertension (n = 10, 11 %). The recommended phase 2 dose was trastuzumab 6 mg/m(2) (loading = 8 mg/m(2)) and bevacizumab 15 mg/kg every 3 weeks, with lapatinib 1,250 mg daily (full FDA-approved dose of each drug). One patient (1 %) achieved a complete response (CR); eight (9 %), a partial response (PR) (includes breast (n = 7, one of which was HER2 2+ by IHC) and salivary ductal carcinoma (n = 1); and 14 (15 %), stable disease (SD) ≥6 months (total SD ≥ 6 months/PR/CR =23 (25 %). All patients with PR/CR received prior trastuzumab +/- lapatinib. SD ≥ 6 months/PR/CR rate and time to treatment failure (TTF) correlated with elevated baseline HER2 ECD (N = 75 patients tested) but not with HER2 SNPs. CONCLUSIONS Combination trastuzumab, lapatinib, and bevacizumab was well-tolerated and demonstrated antitumor activity in heavily pretreated patients with advanced malignancy.
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Manzo-Merino J, Contreras-Paredes A, Vázquez-Ulloa E, Rocha-Zavaleta L, Fuentes-Gonzalez AM, Lizano M. The Role of Signaling Pathways in Cervical Cancer and Molecular Therapeutic Targets. Arch Med Res 2014; 45:525-39. [DOI: 10.1016/j.arcmed.2014.10.008] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Accepted: 10/29/2014] [Indexed: 12/24/2022]
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Jackson MW, Rusthoven CG, Fisher CM, Schefter TE. Clinical potential of bevacizumab in the treatment of metastatic and locally advanced cervical cancer: current evidence. Onco Targets Ther 2014; 7:751-9. [PMID: 24876784 PMCID: PMC4037327 DOI: 10.2147/ott.s49429] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The addition of bevacizumab to established therapies for metastatic and locally advanced cervical cancer is an area of evolving research and a potential strategy toward improving historically suboptimal outcomes for women with advanced disease. Bevacizumab, when added to first-line chemotherapy, has now been shown to improve overall survival among women with metastatic cervical cancer, and recent Phase II data suggests it is safe and effective for patients with locally advanced disease treated with curative intent. Here we review the rationale and current evidence for bevacizumab in clinical practice, with an emphasis on the emerging role of bevacizumab in the treatment of metastatic and locally advanced cervical cancer.
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Affiliation(s)
- Matthew W Jackson
- Department of Radiation Oncology, University of Colorado, Denver, CO, USA
| | - Chad G Rusthoven
- Department of Radiation Oncology, University of Colorado, Denver, CO, USA
| | - Christine M Fisher
- Department of Radiation Oncology, University of Colorado, Denver, CO, USA
| | - Tracey E Schefter
- Department of Radiation Oncology, University of Colorado, Denver, CO, USA
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Elit LM, Hirte H. Management of advanced or recurrent cervical cancer: chemotherapy and beyond. Expert Rev Anticancer Ther 2014; 14:319-32. [DOI: 10.1586/14737140.2014.866041] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Willmott LJ, Monk BJ. Cervical cancer therapy: current, future and anti-angiogensis targeted treatment. Expert Rev Anticancer Ther 2014; 9:895-903. [DOI: 10.1586/era.09.58] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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40
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Vici P, Mariani L, Pizzuti L, Sergi D, Di Lauro L, Vizza E, Tomao F, Tomao S, Mancini E, Vincenzoni C, Barba M, Maugeri-Saccà M, Giovinazzo G, Venuti A. Emerging biological treatments for uterine cervical carcinoma. J Cancer 2014; 5:86-97. [PMID: 24494026 PMCID: PMC3909763 DOI: 10.7150/jca.7963] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Accepted: 12/09/2013] [Indexed: 12/13/2022] Open
Abstract
Cervical cancer is the third most common cancer worldwide, and the development of new diagnosis, prognostic, and treatment strategies is a major interest for public health. Cisplatin, in combination with external beam irradiation for locally advanced disease, or as monotherapy for recurrent/metastatic disease, has been the cornerstone of treatment for more than two decades. Other investigated cytotoxic therapies include paclitaxel, ifosfamide and topotecan, as single agents or in combination, revealing unsatisfactory results. In recent years, much effort has been made towards evaluating new drugs and developing innovative therapies to treat cervical cancer. Among the most investigated molecular targets are epidermal growth factor receptor and vascular endothelial growth factor (VEGF) signaling pathways, both playing a critical role in cervical cancer development. Studies with bevacizumab or VEGF receptor tyrosine kinase have given encouraging results in terms of clinical efficacy, without adding significant toxicity. A great number of other molecular agents targeting critical pathways in cervical malignant transformation are being evaluated in preclinical and clinical trials, reporting preliminary promising data. In the current review, we discuss novel therapeutic strategies which are being investigated for the treatment of advanced cervical cancer.
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Affiliation(s)
- Patrizia Vici
- 1. Department of Medical Oncology B, Regina Elena National Cancer Institute, V Elio Chianesi 53, 00144, Rome, Italy
| | - Luciano Mariani
- 2. Department of Gynecologic Oncology, Regina Elena National Cancer Institute, V Elio Chianesi 53, 00144, Rome, Italy ; 3. HPV Unit, Regina Elena National Cancer Institute, V Elio Chianesi 53, 00144, Rome, Italy
| | - Laura Pizzuti
- 1. Department of Medical Oncology B, Regina Elena National Cancer Institute, V Elio Chianesi 53, 00144, Rome, Italy
| | - Domenico Sergi
- 1. Department of Medical Oncology B, Regina Elena National Cancer Institute, V Elio Chianesi 53, 00144, Rome, Italy
| | - Luigi Di Lauro
- 1. Department of Medical Oncology B, Regina Elena National Cancer Institute, V Elio Chianesi 53, 00144, Rome, Italy
| | - Enrico Vizza
- 2. Department of Gynecologic Oncology, Regina Elena National Cancer Institute, V Elio Chianesi 53, 00144, Rome, Italy
| | - Federica Tomao
- 4. Department of Gynaecology and Obstetrics, "La Sapienza" University, V Policlinico 155, 00161, Rome, Italy
| | - Silverio Tomao
- 5. Department of Medical-Surgical Sciences and Biotechnologies, "La Sapienza" University of Rome, Oncology Unit, C.so della Repubblica, 04100, Latina, Italy
| | - Emanuela Mancini
- 2. Department of Gynecologic Oncology, Regina Elena National Cancer Institute, V Elio Chianesi 53, 00144, Rome, Italy
| | - Cristina Vincenzoni
- 2. Department of Gynecologic Oncology, Regina Elena National Cancer Institute, V Elio Chianesi 53, 00144, Rome, Italy
| | - Maddalena Barba
- 1. Department of Medical Oncology B, Regina Elena National Cancer Institute, V Elio Chianesi 53, 00144, Rome, Italy ; 6. Scientific Direction, Regina Elena National Cancer Institute, V Elio Chianesi 53, 00144, Rome, Italy
| | - Marcello Maugeri-Saccà
- 1. Department of Medical Oncology B, Regina Elena National Cancer Institute, V Elio Chianesi 53, 00144, Rome, Italy ; 6. Scientific Direction, Regina Elena National Cancer Institute, V Elio Chianesi 53, 00144, Rome, Italy
| | - Giuseppe Giovinazzo
- 7. Department of Radiation Oncology, Regina Elena National Cancer Institute,V Elio Chianesi 53, 00144, Rome, Italy
| | - Aldo Venuti
- 3. HPV Unit, Regina Elena National Cancer Institute, V Elio Chianesi 53, 00144, Rome, Italy ; 8. Laboratory of Virology, Regina Elena National Cancer Institute, V Elio Chianesi 53, 00144, Rome, Italy
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Dueñas-Gonzalez A, Cetina L, Coronel J, Cano C, Dolores R. New pharmacotherapy options for cervical cancer. Expert Opin Pharmacother 2013; 15:51-60. [PMID: 24206031 DOI: 10.1517/14656566.2014.855198] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Cervical cancer is the fourth leading cause of cancer death in females worldwide. Incorporation of chemotherapy to radiation in locally advanced disease and molecular targeted therapy for advanced disease has increased survival; nevertheless, there is room for further improvement. AREAS COVERED This review aims to discuss major recent advances in the treatment of invasive cervical cancer from randomized Phase III trials and ongoing late-stage developments. EXPERT OPINION Combination chemotherapy concurrent with radiation plus adjuvant chemotherapy has demonstrated better survival rates as compared to standard cisplatin chemoradiation and ongoing Phase III trials would eventually confirm these findings. Gemcitabine and paclitaxel are the most evaluated agents added to cisplatin chemoradiation and in the adjuvant setting. Further survival gains combining classical cytotoxics will be limited by toxicity, hence, novel antitumor drugs; in particular angiogenesis inhibitors must be evaluated to increase the efficacy of current chemoradiation regimens. In advanced disease, modest survival gains were recently achieved with cisplatin doublets as compared to single agent cisplatin. Bevacizumab added to standard chemotherapy has for the first time demonstrated that targeted agents are valuable in the treatment of advanced cervical cancer. Ongoing Phase III trials for cervical cancer are limited reflecting the shortage of promising molecules and the need to increase research efforts for this disease.
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Affiliation(s)
- Alfonso Dueñas-Gonzalez
- Unidad de Investigacion Biomédica en Cancer, Instituto de Investigaciones Biomédicas , UNAM/Instituto Nacional de Cancerología , Mexico
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42
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Developments in the systemic treatment of metastatic cervical cancer. Cancer Treat Rev 2013; 39:430-43. [DOI: 10.1016/j.ctrv.2012.05.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Revised: 05/22/2012] [Accepted: 05/27/2012] [Indexed: 11/21/2022]
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Should Bevacizumab Be Continued After Progression on Bevacizumab in Recurrent Ovarian Cancer? Int J Gynecol Cancer 2013; 23:833-8. [PMID: 23640292 DOI: 10.1097/igc.0b013e318290ea69] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ObjectiveThe optimal role of bevacizumab (Bev) in the treatment of ovarian cancer has not yet been established. Furthermore, it is unclear whether there is a benefit of Bev after progression on a Bev-containing regimen in ovarian cancer. The objective of this study was to compare response rates, progression-free survival (PFS), and overall survival between patients who were treated with chemotherapy and Bev after progression on Bev (BAB) versus patients who were treated with chemotherapy without Bev (CWOB).MethodsWe conducted a retrospective chart review of all patients who received treatment with Bev (with or without cytotoxic chemotherapy) for recurrent ovarian cancer at a single institution. Patients who received additional therapy after progression while on Bev were included.ResultsForty-six patients were included (16 CWOB group and 30 BAB). The median number of previous chemotherapy regimens was 2.5 for CWOB compared with 4 for BAB (P= 0.11). Fifty-two percent of patients had an objective response to the first Bev regimen before progressing on Bev. Response rates for the regimen after progression on Bev were 19% (3/16) in the CWOB group and 23% (7/30) in the BAB group (P= 1). Twenty-five percent of the patients who responded to the first Bev regimen and 18% of those who did not respond to the first Bev regimen responded to the second Bev regimen (P= 0.72). The median PFS for patients in the CWOB group was 2.6 months (95% confidence interval [CI], 1.3–5 months), compared with 5.0 months (95% CI, 3.5–7.3 months) for patients in the BAB group (P= 0.01). Overall survival was similar, 9.4 months (95% CI, 5.0–12.0 months) for CWOB versus 8.6 months (95% CI, 5.8–15.5 months) for BAB (P= 0.19). One patient in the BAB group died of a bowel perforation.ConclusionsIn patients previously treated with Bev for recurrent ovarian cancer, the subsequent addition of Bev to cytotoxic chemotherapy increased the PFS compared with patients not receiving a second course of Bev, but did so without an impact on overall survival. The response to the first Bev regimen did not predict whether a patient would respond again to the next Bev regimen. Randomized, larger studies will have to be performed to confirm this observation.
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Multicenter phase II trial of topotecan, cisplatin and bevacizumab for recurrent or persistent cervical cancer. Gynecol Oncol 2013; 130:64-8. [PMID: 23591400 DOI: 10.1016/j.ygyno.2013.04.009] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Revised: 04/04/2013] [Accepted: 04/07/2013] [Indexed: 11/21/2022]
Abstract
OBJECTIVE We evaluated the activity and safety of the combination of topotecan, cisplatin and bevacizumab in patients with recurrent or persistent carcinoma of the cervix. METHODS Eligible patients had persistent or recurrent cervical cancer not amenable to curative intent treatment. No prior chemotherapy for recurrence was allowed. Treatment consisted of cisplatin 50 mg/m(2) day 1, topotecan 0.75 mg/m(2) days 1, 2 and 3 and bevacizumab 15 mg/kgday 1 every 21 days until disease progression or limiting toxicity. The primary endpoint was progression free survival at 6 months. We explored PET/CT as a potential early indicator of response to therapy. RESULTS Twenty-seven eligible patients received a median of 3 treatment cycles (range, 1-19). Median follow-up was 10 months (range, 1.7-33.4). The 6-month PFS was 59% (80% CI: 46-70%). In 26 evaluable patients, we observed 1 CR (4%; 80% CI: 0.4-14%) and 8 PR (31%; 80% CI: 19-45%) lasting a median of 4.4 months. Ten patients had SD (39%; 80% CI: 25-53%) with median duration of 2.2 months. Median PFS was 7.1 months (80% CI: 4.7-10.1) and median OS was 13.2 months (80% CI: 8.0-15.4). All patients were evaluated for toxicity. Grade 3-4 hematologic toxicity was common (thrombocytopenia 82% leukopenia 74%, anemia 63%, neutropenia 56%). Most patients (78%) required unanticipated hospital admissions for supportive care and/or management of toxicities. CONCLUSION The addition of bevacizumab to topotecan and cisplatin results in an active but highly toxic regimen. Future efforts should focus on identification of predictive biomarkers of prolonged response and regimen modifications to minimize toxicity.
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Thaker PH, Melhem-Bertrandt A, Sood AK, Ramondetta LM. Importance of adrenergic pathways in women's cancers. Cancer Biomark 2013; 13:145-54. [PMID: 23912486 PMCID: PMC4144752 DOI: 10.3233/cbm-130324] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The importance of adrenergic pathways in cancer has long been suspected, but now there is mounting epidemiological, preclinical, and clinical evidence of its importance in gynecologic cancers. To date, most of these effects are mediated primarily through the beta 2 adrenergic receptor activation of the tumor cell cyclic AMP-protein kinase A signaling pathway. This review will discuss the current knowledge about the neuroendocrine stress response in gynecologic tumor biology.
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Affiliation(s)
- Premal H. Thaker
- Premal H. Thaker, M.D. Assistant Professor in Gynecologic Oncology Washington University School of Medicine 4911 Barnes Jewish Hospital Plaza 4 Floor Maternity Building, Campus Box 8064 St. Louis, MO 63110 Phone: 314-747-3604 Fax: 314-362-2893
| | - Amal Melhem-Bertrandt
- Amal Melhem-Bertrandt, M.D. Assistant Professor in Department of Breast Medical Oncology M.D. Anderson Cancer Center 1155 Herman Pressler Unit 1354 Houston, TX 77030 Phone: 713-792-2817 Fax: 713-794-4385
| | - Anil K. Sood
- Anil K., Sood, M.D. Professor and Vice Chair, Departments of Gynecologic Oncology and Cancer Biology Co-Director, Center for RNA Interference and Non-Coding RNA M.D. Anderson Cancer Center 1155 Herman Pressler Unit 1362 Houston, TX 77030 Phone: 713-745-5266 Fax: 713-792-7586
| | - Lois M. Ramondetta
- Anil K., Sood, M.D. Professor and Vice Chair, Departments of Gynecologic Oncology and Cancer Biology Co-Director, Center for RNA Interference and Non-Coding RNA M.D. Anderson Cancer Center 1155 Herman Pressler Unit 1362 Houston, TX 77030 Phone: 713-745-5266 Fax: 713-792-7586
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Prediction of progression-free survival and response to paclitaxel plus carboplatin in patients with recurrent or advanced cervical cancer. Int J Gynecol Cancer 2012; 22:623-9. [PMID: 22343974 DOI: 10.1097/igc.0b013e3182473277] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE The aim of this study was to identify predictors of the response to paclitaxel-carboplatin chemotherapy (TC) in recurrent or patients with advanced cervical cancer. METHODS The records of 61 consecutive women with recurrent or advanced cervical cancer who were treated with TC were retrospectively reviewed. Data regarding their primary disease, follow-up, recurrence, and the activity and toxicity of TC were collected. Multivariate analysis was performed using the Cox proportional hazards regression model to identify predictors of the response to TC. Survival was calculated using the Kaplan-Meier method and compared using the log-rank test. RESULTS Overall, TC was well tolerated and displayed a response rate of 60.7% (19 complete response and 18 partial response). The median progression-free survival was 14 months for all patients and 20 months for the responders. Grade 3 to grade 4 toxicities were observed in 51 patients (83.6%). Multivariate analysis revealed that performance status, symptom status, and prior chemotherapy were independent prognostic predictors of a poor response. Patient survival was inversely correlated with the number of these prognostic factors. When the patients were divided into 2 prognostic groups (low risk: patients with no or one poor prognostic factor; and high-risk: patients with 2 or more poor prognostic factors), the patients in the high-risk group had a significantly shorter progression-free survival than those in the low-risk group (4 vs 16 months, log-rank; P < 0.0001). CONCLUSIONS The combination of paclitaxel and carboplatin is effective in patients with recurrent or advanced cervical cancer. Our prognostic model composed of 3 clinical variables might enable physicians to identify patients who would not derive clinical benefit from TC and offer them the opportunity to receive other types of treatment.
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Bellati F, Napoletano C, Gasparri ML, Ruscito I, Marchetti C, Pignata S, Tomao F, Benedetti Panici P, Nuti M. Current knowledge and open issues regarding Bevacizumab in gynaecological neoplasms. Crit Rev Oncol Hematol 2012; 83:35-46. [DOI: 10.1016/j.critrevonc.2011.09.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2010] [Revised: 08/10/2011] [Accepted: 09/30/2011] [Indexed: 10/15/2022] Open
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Dueñas-Gonzalez A, Cetina L, Coronel J, Cervantes-Madrid D. Emerging drugs for cervical cancer. Expert Opin Emerg Drugs 2012; 17:203-18. [DOI: 10.1517/14728214.2012.683409] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Zagouri F, Sergentanis TN, Chrysikos D, Filipits M, Bartsch R. Molecularly targeted therapies in cervical cancer. A systematic review. Gynecol Oncol 2012; 126:291-303. [PMID: 22504292 DOI: 10.1016/j.ygyno.2012.04.007] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Revised: 04/03/2012] [Accepted: 04/04/2012] [Indexed: 12/22/2022]
Abstract
Cervical cancer represents the third most common cause of female cancer mortality. Even with the best currently available treatment, a significant proportion of patients will experience recurrence and eventually die. Evidently, there is a clear need for the development of new agents with novel mechanisms of action in this disease. A number of biological agents modulating different signal transduction pathways are currently in clinical development, inhibiting angiogenesis, targeting epidermal growth factor receptor, cell cycle, histone deacetylases, cyclooxygenase-2 (COX-2), or mammalian target of rapamycin (mTOR). This is the first systematic review of the literature to synthesize all available data emerging from trials and evaluate the efficacy and safety of molecularly targeted drugs in cervical cancer. However, it should be stressed that relatively fewer molecularly targeted agents have been tested in cervical cancer in comparison with other cancer types; of note, no related phase 3 trials have been published and consequently no agent has been approved for use in clinical practice. Nevertheless, the promising results of bevacizumab in therapeutic trials for cervical cancer have shown that targeting the VEGF pathway is an attractive therapeutic strategy. As knowledge accumulates on the molecular mechanisms underlying carcinogenesis in the cervix, the anticipated development and assessment of molecularly targeted agents may offer a promising perspective for cervical cancer.
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Affiliation(s)
- Flora Zagouri
- Comprehensive Cancer Center Vienna, Department of Medicine I/Division of Oncology, Medical University of Vienna, Austria.
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Peiretti M, Zapardiel I, Zanagnolo V, Landoni F, Morrow CP, Maggioni A. Management of recurrent cervical cancer: a review of the literature. Surg Oncol 2012; 21:e59-66. [PMID: 22244884 DOI: 10.1016/j.suronc.2011.12.008] [Citation(s) in RCA: 121] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2011] [Revised: 11/27/2011] [Accepted: 12/21/2011] [Indexed: 10/14/2022]
Abstract
OBJECTIVE The aim of this narrative review is to update the current knowledge on the treatment of recurrent cervical cancer based on a literature review. MATERIAL AND METHODS A web based search in Medline and CancerLit databases has been carried out on recurrent cervical cancer management and treatment. All relevant information has been collected and analyzed, prioritizing randomized clinical trials. RESULTS Cervical cancer still represents a significant problem for public health with an annual incidence of about half a million new cases worldwide. Percentages of pelvic recurrences fluctuate from 10% to 74% depending on different risk factors. Accordingly to the literature, it is suggested that chemoradiation treatment (containing cisplatin and/or taxanes) could represent the treatment of choice for locoregional recurrences of cervical cancer after radical surgery. Pelvic exenteration is usually indicated for selected cases of central recurrence of cervical cancer after primary or adjuvant radiation and chemotherapy with bladder and/or rectum infiltration neither extended to the pelvic side walls nor showing any signs of extrapelvic spread of disease. Laterally extended endopelvic resection (LEER) for the treatment of those patients with a locally advanced disease or with a recurrence affecting the pelvic wall has been described. CONCLUSIONS The treatment of recurrences of cervical carcinoma consists of surgery, and of radiation and chemotherapy, or the combination of different modalities taking into consideration the type of primary therapy, the site of recurrence, the disease-free interval, the patient symptoms, performance status, and the degree to which any given treatment might be beneficial.
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Affiliation(s)
- M Peiretti
- Gynecologic Oncology Department, European Institute of Oncology, Milan, Italy
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