Abstract

Cervical cancer is a leading cause of mortality among women in developing countries. Surgical and radiation therapy have been the standards of care. However, with advanced stages of disease these modalities are decreasingly useful. Investigational therapies involving the concurrent use of chemotherapy with radiation therapy have not demonstrated improved long-term survival in randomized studies. New chemotherapy agents, including the taxanes paclitaxel (Taxol®) and docetaxel and topoisomerase-I inhibitors like irinotecan (CPT-11), demonstrate activity in this disease. The neoangiogenesis inhibitor TNP-470 has also shown signs of clinical activity. Because of the association of papillomavirus with cervical cancer, vaccine strategies have been explored. The vaccine approach has been most successful in animal models. Human vaccine trials are ongoing. Problems facing the latter include limitations of immunogen and identification of appropriate patient subgroups. Biologic therapy has focused on cis-retinoic acid and interferon-α combinations. Although active in untreated patients, the activity in patients with prior radiotherapy or chemotherapy is modest. Trials combining radiation therapy with cis-retinoic acid and interferon-α are ongoing. The investigational treatments of cervical cancer have focused on combination chemoradiation therapy, new chemotherapy drug development, and biologic agents. With increased understanding of papillomavirus, vaccine approaches will be given a higher priority.