宫颈癌二线治疗中的靶向治疗

　　Targeted therapy in second line treatment of cervical cancer

　　B. Basu¹, C. Basu²

　　¹Cancer NOCK, ²Netaji Cancer Research Institute, Kolkata, India

　　Background: Dependence on neoadjuvant chemotherapy in treating cervical cancer is huge in India. We are reporting the results of second line treatment by conventional therapy and Bevacizumab in advanced and bulky early-stage cervical cancer treated in neoadjuvant setting.

　　Methods: Patients with histologically proven primary carcinoma were potentially eligible for this prospective cohort study. The primary endpoint selected was progression-free survival (PFS). Prior chemotherapy was Cisplatin and taxol used in neoadjuvant setting in 3 wks interval for three such. Treatment in second line consisted of methotrexate (200 mg bolus) and cisplatin (80 mg/m²) in first group. Another group got 50 mg/m² of intravenous cisplatin on day 1 with 2500 mg/m oral capecitabine daily in 2 divided doses for 14 consecutive days in 21-day cycles. We used bevacizumab (2 mg/kg), paclitaxel (80 mg/m²), and carboplatin in three cases. Responses were assessed using response evaluation criteria in solid tumors.

　　Results: From 2007 to 2010, 18 cases, 11 from radically operated (n= 58) and 7 from only radiotherapy group (n=22) suffered relapse and metastatic disease within two years of neoadjuvant therapy. 16 cases were treated in second line; 8 cases had methotrexate, five cases capecitabine and three cases had Bevacizumab. Complete response was noticed in two cases of Bevacizumab group. Methotrexate group median time to progression was 4 months (95% CI - 0.13 to 3.97), with a median overall survival of 5.5 months. Capecitabine group median time to progression was 5.5 months (95% CI- 0.25 to 7.50), with a median overall survival of 7 months. There was not much difference in the toxicity profile amongst groups.

　　Conclusion: Results of second line chemotherapy in cervical cancer are unsatisfactory. There is need for combining targeted therapy with conventional chemotherapy. However, prohibitive cost is cause of concern for such therapy in India.

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