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Chemotherapy for recurrent, metastatic, or persistent cervical cancer: a systematic review
  1. H. W. Hirte*,,
  2. J. E. Strychowsky,
  3. T. Oliver,§,
  4. M. Fung-Kee-Fung,
  5. L. Elit#,** and
  6. A. M. Oza,
  1. * Department of Medical Oncolgy, Juravinski Regional Cancer Centre, Hamilton, Ontario, Canada;
  2. Department of Medicine and Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada;
  3. Program in Evidence-based Care, Cancer Care Ontario, Hamilton, Ontario, Canada;
  4. § Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada;
  5. Department of Obstetrics and Gynecology and Department of Surgery, University of Ottawa/Ottawa Regional Cancer Centre, Ottawa, Ontario, Canada;
  6. # Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario;
  7. ** Division of Gynecologic Oncology, Juravinski Regional Cancer Cantre, Hamilton, Ontario; and
  8. †† Princess Margaret Hospital, Department of Medical Oncolgy, Toronto, Ontario, Canada.
  1. Address correspondence and reprint requests to: Hal W. Hirte, MD, Program in Evidence-Based Care, McMaster University, 1280 Main Street West, T27, 3rd Floor, Hamilton, Ontario L8S 4L8, Canada. Email: olivert{at}


To determine the front-line chemotherapeutic options for women with recurrent, metastatic, or persistent cervical cancer. The Medline, Embase, and Cochrane Library databases were searched for randomized controlled trials (RCTs) comparing chemotherapy regimens for patients with recurrent, metastatic, or persistent cervical cancer. Studies were included if response rate, survival, toxicity, or quality of life data were reported. Fifteen RCTs were identified. The proportion of patients with prior chemoradiotherapy ranged from 0% to 57%. Four of the 15 RCTs detected significant improvements in overall response with combination cisplatin-based chemotherapy when compared with single-agent cisplatin. One of the 15 RCTs reported a significant median survival advantage with topotecan and cisplatin when compared with single-agent cisplatin (9.4 vs 6.5 months, P= 0.017); 57% of patients in this trial had previous chemoradiotherapy. Significant increases in grade 3 and 4 adverse events, especially severe hematologic toxicities, were detected among patients treated with that combination of chemotherapy. Thus, we conclude that cisplatin and topotecan should be discussed as a reasonable treatment option for appropriate patients who may wish to maximize the response and survival benefits associated with combination chemotherapy. Patients should understand that prior chemoradiotherapy with cisplatin may moderate the benefits observed, and that the relative benefits in response and survival outcomes come at the expense of increased toxicity. The improvement in median survival of 2.9 months represents a novel survival benefit in this difficult-to-treat patient population. Further randomized trials are needed to inform the role of single-agent or combination chemotherapy regimens, particularly in patients with prior chemoradiotherapy.

  • cervical cancer
  • cervix neoplasms
  • chemotherapy
  • drug therapy
  • recurrence
  • recurrent

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