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Pre-Exenterative Chemotherapy Shows Promise in Tough-to-Treat Cervical Cancer: Presented at ICACT

By Jill Stein

PARIS, FRANCE -- February 8, 2007 -- Pre-exenterative chemotherapy represents an option for cervical cancer patients who are not usually considered candidates for classical pelvic exenteration because of the extent of pelvic disease, investigators reported here at the 18^th International Congress on Anti-Cancer Treatment (ICACT).

Carlos Lopez-Graniel, MD, professor, oncology division, National Cancer Institute in Mexico City, Mexico, and colleagues, presented results in 46 women treated from May 1998 to October 2006.

All study participants had recurrent or persistent cervical cancer and no evidence of systemic disease, and they were considered ineligible for pelvic exenteration because of the extent of their pelvic tumors. Most patients in this series had squamous tumors and were International Federation of Gynecology & Obstetrics stage IIB.

"Although pelvic exenteration plays an important role in the management of recurrent cervical cancer, its overall impact on the disease has remained unchanged, since it continues to be indicated in a highly select group of patients with pelvic recurrences," Dr. Lopez-Graniel explained in his presentation on February 7^th. "Thus, most cervical cancer patients with pelvic recurrent or persistent disease are treated with chemotherapy."

"In order to boost the number of patients who might benefit from this salvage therapy, we developed the modality of pre-exenterative chemotherapy based on the hypothesis that systemic chemotherapy would shrink the pelvic recurrent tumor and thus allow us to attempt a 'standard' pelvic exenteration."

After patients received 3 courses of IV cisplatinum, they were evaluated for response by bimanual pelvic examination and pelvic computed tomography scan. Toxicity to chemotherapy was evaluated by standard World Health Organization criteria. All women underwent an exploratory laparotomy, and pelvic exenteration was attempted.

Objective responses were observed in 45.6% patients. Disease-free margins were obtained in all but 2 cases.

Chemotherapy was well tolerated.

Mean duration of surgery was 5.5 hours, and mean duration of hospitalization was 12.9 days.

Dr. Lopez-Graniel said that while the results were extremely encouraging, the true role of pre-exenterative chemotherapy in managing recurrent disease will only be elucidated in a phase 3 trial.


[Presentation title: Pre-Exenterative Chemotherapy, a Novel Therapeutic Approach for Patients with Persistent or Recurrent Cervical Cancer. Abstract 192]

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