Elsevier

Gynecologic Oncology

Volume 133, Issue 1, April 2014, Pages 117-123
Gynecologic Oncology

Review
A systematic review comparing cisplatin and carboplatin plus paclitaxel-based chemotherapy for recurrent or metastatic cervical cancer

https://doi.org/10.1016/j.ygyno.2014.01.042Get rights and content

Highlights

  • Platinum-taxane combinations are active agents in advanced cervical cancer.

  • Which of cisplatin or carboplatin is the better platinum agent when combined with paclitaxel is a matter of debate.

  • We report a review of cisplatin- vs carboplatin-taxane studies that confirms similar outcome for the two doublets.

Abstract

Introduction

The prognosis of advanced/recurrent cervical cancer patients is generally poor with 1-year survival ranging between 15 and 20%. Cisplatin (CDDP) based treatments are considered the most effective regimens; unfortunately toxicity is an issue in a population in which the treatment remains palliative in the finality. Carboplatin (CBDCA), with its more favorable non toxicity profile and the convenience of outpatient administration, may be a suitable alternative to CDDP in combination regimens.

Materials and methods

We performed a systematic review of the literature comparing CDDP and CBDCA based chemotherapy for advanced cervical cancer (recurrent, persistent or metastatic disease). Only studies that met the following criteria were considered for the present review: 1) patients treated with CDDP/paclitaxel or CBDCA/paclitaxel combinations as first line chemotherapy for metastatic disease; 2) one or more of the following data available: overall response rate (RR), progression free survival (PFS) or time to progression (TTP), overall survival (OS); 3) single-arm retrospective or prospective study; and 4) at least 20 patients enrolled.

Results

17 eligible studies comprehensive of 1181 patients were included in the final analysis. The objective RR was 48.5% for CBDCA and 49.3% for CDDP-based chemotherapy. Median PFS for CDDP and CBDCA-based treatments was 6.9 months and 5 months respectively (p = 0.03); the corresponding figures for median OS were 12.87 and 10 months respectively (p = 0.17).

Discussion

Our study indicates that CBDCA may represent an attractive and valid alternative to the more toxic and equally effective CDDP in the treatment of advanced or recurrent cervical cancer.

Introduction

Cervical cancer is still a leading cause of cancer-related death in women, accounting for 14% of all deaths due to gynecologic cancers worldwide [1]. Although several advances in screening, diagnostic and treatment modalities have been made, the overall prognosis of cervical cancer has not changed dramatically, and the mortality still approaches 50%. The treatment of choice of cervical cancer is represented by radiotherapy or surgery for early stage disease and concurrent chemoradiation for advanced stage patients. Chemotherapy remains an option for metastatic patients (FIGO stage IVB) or persistent/recurrent disease after primary treatment not suitable for curative surgery or radiotherapy. The prognosis of advanced/recurrent patients generally remains poor with 1-year survival ranging between 15 and 20% [2]. Single agent cisplatin (CDDP) is considered the most active agent in the treatment of advanced/recurrent disease [3], and the combination of CDDP-paclitaxel (P) has been reported to be better to CDDP monotherapy in terms of response rate (RR), progression free survival (PFS) but not overall survival (OS) [4]. The recently closed GOG 204 moreover reported CDDP-P as the most active combination in the treatment of advanced or recurrent cervical cancer [5] thus confirming the treatment as the new standard of care in advanced cervical carcinoma. Unfortunately, the toxicity of the treatment and the discomfort of the schedule, with P given as 24-hour infusion in order to minimize neurologic toxicity, make the combination hardly to propose in a setting of disease where, despite the improved clinical outcomes, all treatments remain palliative in the finality. In this context, CBDCA, with its more favorable toxicity profile and the convenience of the outpatient administration, may be a suitable substitute of CDDP in combination regimens. In ovarian cancer, CBDCA has been reported to be equally effective than CDDP but better tolerated [6], [7]. Recently a randomized JCOG phase III trial on stage IVB, persistent or recurrent cervical cancer reported that CBDCA-P is equally effective with respect to CDDP-P in terms of PFS and OS, the latter being more efficacious in chemo naive patients [8]. We performed a systematic review of the literature comparing CDDP and CBDCA paclitaxel-based chemotherapy for recurrent or metastatic cervical cancer in order to describe the activity and outcomes associated with both doublets.

Section snippets

Literature search

PubMed, EMBASE, Web of Science and The Cochrane Library were systematically searched in March 2013, to identify relevant publications. Keywords included in the search were “uterine cervical neoplasm [Mesh]”, “cisplatin or carboplatin”, “paclitaxel” and “recurrent or relapsed or advanced or metastatic”. The literature search was limited to “human studies” in “English” language. We also reviewed conference abstracts to identify unpublished papers. All potentially relevant studies were retrieved,

Literature search and study characteristics

The flow of study selection is reported in Fig. 1. Initially, 860 references were identified (PubMed: n = 138, Web of Science: n = 262, Cochrane register of Controlled trials: n = 26, EMBASE: n = 434). After careful selection, a total of 17 eligible studies comprehensive of 1181 patients were included in the final analysis (7 for CBDCA/paclitaxel analysis, 9 for CDDP/paclitaxel analysis and 1 for both analyses) [4], [5], [8], [11], [12], [13], [14], [15], [16], [17], [18], [19], [22], [23], [24], [25],

Discussion

The experience with substituting CBDCA for CDDP is limited in advanced or recurrent uterine cervical cancer, and our systematic literature review seems to confirm that CDDP and CBDCA are equally effective in the treatment of the disease. Traditionally CDDP, with RRs ranging from 20 to 30% and OS of 7 months [20], has been considered the most effective single agent for cervical cancer treatment. Even in the absence of a direct comparison, other platinum analogs were considered less active than

Conflict of interest statement

The authors declare no conflict of interest.

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