Clinical Scenario

This protocol addresses cervical cancer presenting as primary FIGO stage IVB (distant metastatic disease) or as recurrent or persistent disease after prior local or regional management. The patient has a performance status below 2, making them eligible for systemic palliative therapy.

Eligibility — Performance Status

Palliative chemotherapy with the aim of relieving symptoms and improving quality of life is indicated when the patient has a PS below 2 and no formal contraindications. Good performance status (PS 0 or 1) with measurable disease defines the population for whom this first-line approach is appropriate.

Treatment Approach — Partial Overview

Palliative first-line combination chemotherapy incorporating a platinum-based backbone together with a targeted agent forms the basis of this regimen. An alternative platinum-based combination exists for patients who are not candidates for the primary platinum agent. The complete regimen, eligibility criteria, and full decision algorithm are available in the structured protocol.

References

DOI: 10.1093/annonc/mdx220

Palliative chemotherapy with the aim of relieving symptoms and improving quality of life is indicated if the patient has a PS < 2 and no formal contraindications.
Patients with primary stage IVB or recurrent/persistent, good PS (0 or 1) and measurable disease were randomised to paclitaxel–cisplatin or paclitaxel–topotecan, both with or without bevacizumab.
Paclitaxel and cisplatin combined with bevacizumab is considered the preferred first-line regimen in metastatic or recurrent cervical cancer based on the balance between efficacy and toxicity profile [I, A].
The combination of paclitaxel and carboplatin could be considered an alternative for patients that are not candidates for cisplatin.

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First-Line Treatment of Cervical Cancer at Primary FIGO Stage IVB or Recurrent / Persistent Disease

References