Management of Recurrent or Residual Cervical Cancer with Cisplatin and Topotecan Combination Therapy in a Palliative Setting: A Prospective Study

Context: Treatment options for patients with recurrent or residual cervical tumour are limited. Several new cytotoxic drugs have been recently investigated, comparing single agent with multiple drugs combination. The uses of chemotherapy in these cases are considered palliative because of low response rates and a negligible impact on long-term survival. Aims and Objectives: To evaluate the efficacy and side effects of cisplatin plus topotecan combined chemotherapy in persistent or recurrent cervical cancer not amenable to curative treatment by surgery and/or radiation and to evaluate the median progression-free interval and overall survival after the completion of treatment. Materials and Methods: In total, 17 patients with residual or recurrent cervical cancer were enrolled in this trial. They were given a standard dose of chemotherapy according to their body surface area, i.e. topotecan 0.75 mg/m2 intravenously on day 1, 2 and 3, and cisplatin 50 mg/m2 intravenously on day 1. Treatments were repeated every 21 days for 6 cycles or until disease progression or unacceptable toxicities and then followed up 3 months for 1 year. OS and PFS rates were estimated by means of the Kaplan–Meier method. Toxicities analysis was also done. Results: Topotecan and cisplatin combined chemotherapy was well tolerated by all the patients with grade 2 neutropenia, leukopenia and thrombocytopenia occurring in 5.8%, anaemia in 53% and mild nausea in 11.8%. There were complete remission in 2 patients (11.8%) and partial remission in another 3 patients (17.6%) at the end of study with overall response of 29.4%. There were 3 patients (17.6%) with stable disease. The median OS was 10 months, and the median PFS was 4 months. Conclusion: Topotecan and cisplatin combination was found to be effective, safe and well tolerated in patients with persistent or recurrent cervical cancer. © 2018, Association of Gynecologic Oncologists of India.