Background

Prognosis for recurrent or metastatic cervical cancer remains poor. Studies have shown that cisplatin is the most effective single agent, and when used in combination with topotecan it has been shown to improve the response rate and overall survival.¹

Method

A retrospective audit of all patients receiving cisplatin-topotecan chemotherapy for recurrent/metastatic cervical cancer in south-east Scotland (2008-2011) was done. Data collected includes; age, stage at presentation, pathology, primary treatment, site/timing of relapse, use/toxicity of palliative chemotherapy.

Results

24 patients with median age 38.5 years. 22 had relapsed disease, 2 presented with stage IV disease. Histology; squamous cell carcinoma 20, adenocarcinoma 3, neuroendocrine 1. 79% (16) had received prior cisplatin with radiotherapy and 21% (5) were chemo-naive. Median time to relapse was 26 months (5 months - 20.1 years). Response rate to cisplatin-topotecan was 22%. Median overall survival was 51.4 weeks (12.5 - 134); 52.4 v.s. 51.4 weeks in prior cisplatin v.s cisplatin-niave; 40.7 v.s 52.7 weeks for recurrence in RT field v.s distant disease. Fatigue and nausea were the most frequently reported toxicities (G1/2). 38% (9) reported G3/4 toxicities; myelosupression 9, fatigue 1, nausea 1, diarrhoea 1. 8 patients (33%) had 2nd-line treatment; median time from 1st to 2nd line chemotherapy 6 months (2-12) with response to 2nd line carboplatin-paclitaxel; 1 partial response, 2 stable disease, 4 progressive disease. 17 deaths during audit period due to progressive disease.

Conclusion

Overall survival in is in keeping with published series with appreciable survival even in patients exposed to cisplatin with RT. Cisplatin-topotecan was well tolerated and there were no chemotherapy related deaths. This audit supports continuing current practice of cisplatin-topotecan as first line therapy in recurrent/metastatic cervical cancer.