Medical Students 2011 - J.B. Vermorken - GYNAECOLOGICAL CANCER SESSION - Cervical Cancer
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Medical Students 2011 - J.B. Vermorken - GYNAECOLOGICAL CANCER SESSION - Cervical Cancer
- 1. Cervical Cancer Clinical Presentation, Diagnosis, Staging (1) Treatment (2) Jan B. Vermorken, MD, PhD Department of Medical Oncology Antwerp University Hospital Edegem, Belgium ESO student course, Ioannina, 2011
- 2. < 87.3 < 16.2 < 32.6 < 9.3 < 26.2 2009 11,270 cases* 2009 4,070 deaths* Estimates of the Worldwide Incidence of Cervical Cancer / 100,000 women GLOBOCAN 2002; IARC. / 100,000 women *American Cancer Society Facts and Figures 2009
- 13. FIGO Classification (2009) Stage I: carcinoma confined to the cervix IA: No clinically visible lesion IB: clinically visible lesion IB1: tumor ≤ 4 cm IB2: tumor > 4 cm
- 14. FIGO Stage II: I nvasion beyond the uterus, but not to the pelvic wall or to the lower third of the vagina IIA: Without parametrial invasion (IIA1 ≤4.0 cm IIA2 > 4.0 cm) IIB: With obvious parametrial invasion
- 15. FIGO Stage III Stage IV: IVA: Extension to the rectum or the bladder IVB: Extension to distant organs IIIA: Invasion to the lower third of the vagina IIIB : Invasion to the pelvic wall and/or with hydronephrosis
- 16. Treatment of Cervical Cancer “ What is standard?” “ What is new?”
- 22. New Cytotoxic Agents in R/M Cervical Cancer Agent No. studies No. pts Prior CT RR Paclitaxel 2 87 -/+ 17 - 25 Docetaxel 1 18 -/+ 25 Irinotecan 5 218 -/+ 0 - 24 Topotecan 3 105 -/+ 13 – 18 Vinorelbine 2 81 - 17 – 18 Gemcitabine 3 92 -/+ 8 - 11
- 23. Four-arm Trial in Stage IVB, Recurrent or Persistant Cervial Carcinoma: GOG #204 cisplatin + paclitaxel Stage IVB cisplatin + topotecan Recurrent CC cisplatin + vinorelbine Persistent CC cisplatin + gemcitabine May 2003-April 2007, 513 pts enrolled. Interim analysis (April 2007): closure (advantage unlikely) Monk BJ et al, J Clin Oncol 2009; 4649-4655 R A N D O M I Z E
- 24. GOG 204 Progression-Free Survival Monk BJ et al, J Clin Oncol 2009; 4649-4655
- 25. GOG 204 Overall Survival Monk BJ et al, J Clin Oncol 2009; 4649-4655
- 27. GOG 240 Schema Eligibility : 1. Primary stage IVB or Recurrent/persistent carcinoma of the cervix 2. Measureable disease 3. GOG PS 0-1 Regimen I Paclitaxel 135 mg/m 2 IV d1 (24 h) Cisplatin 50 mg/m 2 IV d2 Q21d to progression/toxicity Regimen II Paclitaxel 135 mg/m 2 IV d1 (24 h) Cisplatin 50 mg/m 2 IV d2 Bevacizumab 15 mg/kg IV d2 Q21d to progression/toxicity Regimen IV Paclitaxel 175 mg/m 2 IV d1 (3 h) Topotecan 0.75 mg/m 2 d1-3 (30 m) Bevacizumab 15 mg/kg IV d1 Q21d to progression/toxicity Regimen III Paclitaxel 175 mg/m 2 IV d1 (3 h) Topotecan 0.75 mg/m 2 d1-3 (30 m) Q21d to progression/toxicity R A N D O M I Z E