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
P a c lita x el 135 or 175 m g /m2 IVC 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
