La terapia medica

M A S TE R D I II LIV E LLO

“P A TH W A Y S IN G Y N E C O LO G IC A L O N C O LO G Y ”

L a c hirurg ia pelvic a exentera tiva : indic a zioni e lim iti

La terapia medica

Annamaria Ferrero

S C DU Ginecologia

AO Ordine Mauriziano Torino

Giovedì, 26 novembre 2015

Non esiste un trattamento standard per le recidive, che dipende dalla sede

Le recidive in zona irradiata sono particolarmente difficili da trattare

In caso di recidiva locale l’eviscerazione pelvica trova indicazione in pazienti

selezionate

La prognosi peggiora in caso di recidiva a distanza (linee guida sul trattamento







CARCINOMA della CERVICE UTERINA e dell’ENDOMETRIO: recidive



GOG 240: Schema

KS Tewari (study chair). www.ClinicalTrials.gov Identifier: NCT00803062.

Activated: 4/6/09 Closed to accrual: 1/3/12

R A N D O M I Z E

Presented by: Krishnansu S. Tewari, MD, FACOG, FACS

C a rc inom a of the c ervix

•Primary stage IVB

•Recurrent/persistent

•Measureable disease

•GOG PS 0–1

•No prior chemotherapy for recurrence

(N=452)

S tratification factors :

•Stage IVB vs recurrent/persistent disease

•Performance status

•Prior cisplatin Rx as radiation- sensitizer

1:1:1:1

I

C is pla tin 50 m g /m² IV

II I

P a c lita xel 175 m g /m² IV Topotec a n 0.75 m g /m² d1-

3

Chemo alone

I I

P a c lita xel 135 or 175 m g /m² IV

C is pla tin 50 m g /m² IV B eva c izum a b 15 m g /k g IV

I V

P a c lita x el 175 m g /m² IV Topotec a n 0.75 m g /m² d1-

3

B eva c izum a b 15 m g /k g IV

Q21d Rx to PD, toxicity, CR

Chemo + Bev

Chemotherapy (n=225) Events, n (%) 140 (62) Median OS, mos 13.3

Chemotherapy + Bev (n=227)

131 (58) 17.0 HR=0.71 (97% CI, 0.54-0.94)

P=0.0035

GOG 240: OS for Chemo vs Chemo + Bev

0.0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1.0

0 12 24 36

Proportion Surviving

Months on Study

Median follow-up 20.8 mos

Chemotherapy + Bev (n=227)

183 (81)

8.2 HR=0.67 (95% CI, 0.54-0.82)

2-sided P=0.0002

GOG 240: PFS for Chemo vs Chemo + Bev

Presented by: Krishnansu S. Tewari, MD, FACOG, FACS

0.0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1.0

0 12 24 36

Proportion Progression-Free

Months on Study

Chemotherapy (n=225) Events, n (%) 184 (82)

Median PFS, mos 5.9

RR, % 36 (CR, n=14) 48 (CR, n=28)

2-sided P=0.00807

 Patients with metastatic or recurrent cervical cancer are commonly symptomatic. The role of chemotherapy in such patients is palliative with primary objective being to relieve symptoms and improve QoL

 Cisplatin is considered the single mot active cytotoxic agent

 Combination regimens include cisplatin/paclitaxel (preferred option due to toxicity burden) and cisplatin/topotecan

Carboplatin can replace cisplatin when combined with paclitaxel in case of prior cisplatin-based treatment

 The addition of bevacizumab to combination chemotherapy can be considered in properly selected patient with

recurrent, persistent or metastatic disease (increase of OS

What are the best evidence- based systemic treatment

strategies for

recurrent cervical cancer?

Recidive pelviche in pazienti non preirradiate

RT (esterna , brachiterapia) associata o meno ad exeresi chirurgica

Recidive pelviche in pazienti già radiotrattate

CT associata o meno ad exeresi chirurgica





CARCINOMA dell’ENDOMETRIO: recidive

 There is no standard second-line chemotherapy regimen

 Antracyclines, platinum-based regimens and taxanes are the most active chemotherapy agents

Hormone therapy is an option

 MPA 200 mg or MA 160 mg are generally

recommended, other agents, including tamoxifen, fulvestrant and aromatase inhibitors, can also be considered

Clinical trials with targeted agents are required to investigate the relevance of gene abnormalities and aberrant signalling pathways that appear to be

What are the best evidence-based systemic treatment strategies for

recurrent endometrial cancer?