Search

The management of advanced cervical cancer has evolved with time. Combined modality treatments for cervical cancer have been shown to improve clinical outcomes for these patients. The role of surgery is reviewed in this article for specific situations such as the treatment of bulky lymph nodes and even in the metastatic setting. External beam radiotherapy and brachytherapy techniques have improved which has decreased patient toxicity. Systemic therapy such as chemotherapy, immunotherapy, and novel sensitizing agents have been extensively studied and have shown promising results. The combination of these three different modalities of treatment can be tailored to each specific patient to achieve the best outcomes. We review the recent advances and various international guidelines for the management of cervical cancer in this article.

Contains fulltext : 283536.pdf (Publisher’s version ) (Closed access) The Gynecologic Cancer InterGroup (GCIG) sixth Ovarian Cancer Conference on Clinical Research was held virtually in October, 2021, following published consensus guidelines. The goal of the consensus meeting was to achieve harmonisation on the design elements of upcoming trials in ovarian cancer, to select important questions for future study, and to identify unmet needs. All 33 GCIG member groups participated in the development, refinement, and adoption of 20 statements within four topic groups on clinical research in ovarian cancer including first line treatment, recurrent disease, disease subgroups, and future trials. Unanimous consensus was obtained for 14 of 20 statements, with greater than 90% concordance in the remaining six statements. The high acceptance rate following active deliberation among the GCIG groups confirmed that a consensus process could be applied in a virtual setting. Together with detailed categorisation of unmet needs, these consensus statements will promote the harmonisation of international clinical research in ovarian cancer.

BACKGROUND: Epithelial ovarian cancer is the sixth most common cancer worldwide: 295,414 new cases were diagnosed in 2018, with 184,799 deaths. The lack of an effective screening strategy has led to the majority of women being diagnosed at an advanced stage. For these women, intravenous carboplatin combined with paclitaxel for six cycles is widely accepted as the standard first‐line treatment for epithelial ovarian cancer, in combination with debulking surgery. However, there is conflicting evidence regarding the optimal dosing schedule of paclitaxel when combined with carboplatin in this setting. OBJECTIVES: To compare the efficacy and tolerability of intravenous weekly paclitaxel with that of tri‐weekly paclitaxel, in combination with intravenous carboplatin, as first‐line treatment for epithelial ovarian cancer (defined as epithelial ovarian, primary peritoneal and fallopian tube cancer). SEARCH METHODS: We searched CENTRAL, MEDLINE, and Embase databases for relevant studies up to 15 November 2021, using keywords and MeSH terms. We additionally handsearched conference libraries, online clinical trial databases and screened through lists of retrieved references. SELECTION CRITERIA: We Included randomised controlled trials (RCTs) comparing weekly paclitaxel in combination with carboplatin versus tri‐weekly paclitaxel in combination with carboplatin, for treatment of newly‐diagnosed epithelial ovarian cancer. DATA COLLECTION AND ANALYSIS: We used the hazard ratio (HR) to estimate the primary efficacy outcomes progression‐free (PFS) and overall survival (OS). We used the risk ratio (RR) to estimate the primary toxicity outcome of severe neutropenia and secondary outcomes of quality of life (QoL) and treatment‐related adverse events. Two review authors independently selected studies, extracted data, and assessed risk of bias, using standard Cochrane methodological procedures. We included individual participant data (IPD) from one of the included studies, ICON‐8, provided by the study team. We analysed data using a random‐effects model in Review Manager 5.4 software. Additionally, we reconstructed IPD for PFS and OS data from published Kaplan‐Meier curves from all studies and subsequently pooled these to analyse the two primary efficacy outcomes. MAIN RESULTS: From 2469 records, we identified four eligible RCTs with data for 3699 participants. All eligible studies were included in the main meta‐analysis and reported on PFS and OS. There was likely a slight improvement in PFS when paclitaxel was dosed weekly compared to tri‐weekly (HR 0.89, 95% confidence interval (CI) 0.81 to 0.98; 4 studies, 3699 participants; moderate‐certainty evidence). We found little to no improvement in OS when paclitaxel was dosed weekly compared to tri‐weekly (HR 0.92, 95% CI 0.79 to 1.06; 4 studies, 3699 participants; high‐certainty evidence). There was likely little to no difference in high‐grade (grade 3 or 4) neutropenia when paclitaxel was dosed weekly compared to tri‐weekly (RR 1.11, 95% CI 0.86 to 1.43; 4 studies, 3639 participants; moderate‐certainty evidence). However, weekly paclitaxel increased high‐grade (grade 3 or 4) anaemia when compared to tri‐weekly dosing (RR 1.57, 95% CI 1.12 to 2.20; 4 studies, 3639 participants; high‐certainty evidence). There may be little to no difference in high‐grade neuropathy when paclitaxel was dosed weekly compared to tri‐weekly (RR 1.12, 95% CI 0.64 to 1.94; 4 studies, 3639 participants; low‐certainty evidence). The overall risk of detection bias and performance bias was low for OS, but was unclear for other outcomes, as treatments were not blinded. The risk of bias in other domains was low or unclear. We note that OS data were immature for three of the included studies (GOG‐0262, ICON‐8 and MITO‐7). AUTHORS' CONCLUSIONS: Weekly paclitaxel combined with carboplatin for first‐line treatment of epithelial ovarian cancer likely improves PFS slightly (moderate‐certainty evidence) but not OS (high‐certainty evidence), compared to tri‐weekly paclitaxel combined with carboplatin. However, this was associated with increased risk for high‐grade anaemia, treatment discontinuation, dose delays and dose omissions (high‐ to low‐certainty evidence). Our findings may not apply to women receiving bevacizumab in first‐line therapy, those receiving treatment in the neo‐adjuvant setting, or those with rare subtypes of clear cell or mucinous ovarian cancer.